Limited sick leave, doubled deductible... How the government plans to save 5.5 billion euros on health spending

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Medical deductibles, long-term illnesses, sick leave... The Minister of Labor, Health, Solidarity and Families, Catherine Vautrin , details the cost-cutting measures to curb health spending next year in an interview with "Le Monde" published this Saturday, July 26, morning.

In mid-July, the Prime Minister called for healthcare spending to be curbed by "around" €5.5 billion next year, notably calling for an effort to "make the French population more responsible ." "Le Nouvel Obs" provides an update on the Health Minister's announcements.

• Doubled medical deductible, to be paid “at the counter”

Catherine Vautrin confirms "the doubling of the ceiling for medical deductibles" to 100 euros per year (i.e. the amounts not reimbursed to the patient, set at 1 euro per box of medication), announced by François Bayrou. Stressing that "we must stop with this idea that health insurance, 'it's free, I'm entitled to it'", she specifies that there will be a ceiling set "at a maximum of 8 euros per month" , and reaffirms that these deductibles will be paid "over the counter" in pharmacies.

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To justify this decision, she repeats the discourse of the social model "structurally in deficit and therefore, by definition, in danger" . While Social Security is about to celebrate its 80th anniversary , the minister also highlights the demographic situation, "extremely worrying" , with the intersection of the birth and death curves . "It is not at all a question of making the French feel guilty, no one chooses to be ill ," she assures. But we want to make those insured take responsibility."

• “Facilitating the exit” from ALD, question on thermal cures

Concerning long-term illnesses (ALD), i.e. 13 million chronic patients fully covered by health insurance, also cited by François Bayrou among the savings measures, Catherine Vautrin indicates that it will first be a question of "facilitating the exit from this regime, when the doctor declares that you are fully cured of a stroke or cancer, for example" .

The minister also announced the abolition of the so-called "non-exempt" ALD system, a status where "care is not 100% covered, but allows for work stoppages of up to three years." She added that the government intends to "question the maintenance of 100% reimbursement of spa treatments and medications whose medical service is low for ALD patients."

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Finally, she believes that "price reductions are necessary" to put an end to situations of "economic rents" in health sectors such as radiology, biology, radiotherapy and dialysis. "They are financed at more than 80% by health insurance and have very high levels of profitability," she argues.

On another sensitive subject, the subject of "drift" according to François Bayrou, that of sick leave , the minister explains that the transfer of the coverage of these leaves, up to the 7th day, to the employer is an avenue "under study" and "must be the subject of discussions with the social partners" . "In this hypothesis, companies would be required to take over this additional waiting period, from the fourth to the seventh day" , she says.

Catherine Vautrin also indicates that the government intends to "put an end to abuses" and wishes to "limit any first sick leave to 15 days in general practice" (there is currently no maximum duration), and to "one month upon discharge from hospital" , the idea being to have "a more regular reassessment of situations" . "As a reminder, the checks that have been carried out on sick leave of more than eighteen months have shown that, for 50% of them, these leave were no longer justified" , she assures.

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The minister announced that the national spending target for the National Health Insurance (Ondam) would be increased by less than 2%, a rate set "before discussions with parliamentarians and stakeholders in the health sector," she said. This technical term means that the budget for hospitals and community medicine would only be slightly increased. Worse, the amount of this budget requires "5 billion euros of savings to be made," said Catherine Vautrin.

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To find the money, she declares that we must "look for all means to be more efficient, everywhere." For hospitals, she mentions in particular the development of outpatient activities (without hospitalization, during the day) or even home hospitalization. "I will also defend very concrete measures, such as that of better reuse, with monitoring through artificial intelligence, of medical equipment," she aims. The minister also brings out the magic proposal of the fight against fraud - 13 billion euros across the entire social field.

In terms of prevention, the minister notes that "85% of nursing home residents are now vaccinated against the flu," estimating that "at least ten additional vaccination rates" remain to be achieved. "To achieve this, I would like vaccination to become mandatory for elderly people in institutions," she says.

She also points to "medical nomadism" , believing that recourse to a second opinion "is completely understandable after the diagnosis of a pathology" , but that "this is not the case for a 3rd, 4th, 5th identical consultation with other practitioners (...) We must limit their care" , she says.

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