The social security expenditure budget voted by Parliament for 2024 reaches nearly 255 billion euros. As a percentage of gross domestic product (12.1%), this places us in 3e position behind the United States (16.6%) and Germany (12.7%); but in dollars per capita per year we are in 7e position with 6,630 dollars, almost 20% less than Germany, if we refer to the figures provided by the “ Health overview 2023 » of the Organization for Economic Co-operation and Development (OECD).
If the Minister of the Economy wants to make savings on health, he is therefore targeting the wrong target and should instead concentrate first on management costs, which place France in 3e position of OECD countries since they represent 5% of health spending – twice the average of OECD countries, behind Switzerland (7%) and the United States (8%).
In fact, for historical reasons, we have a double management of each treatment: once by compulsory health insurance (Social Security) and a second time by complementary insurance (mutuals, provident institutes and insurance companies). ). However, in 2018, the management costs of complementary health insurance were around 20% of turnover, or 7.8 billion, compared to 4% for Social Security, or 6.7 billion. This while Social Security reimburses 80% of care, and supplementary care only 13%.
An increase in the CSG
If, as in Canada, we had only one insurer, we would save 7 billion euros in unnecessary management costs. To do this, we would need to achieve “Grande Sécu” by integrating mutual insurance companies into Social Security and reimbursing 100% of a prevention and solidarity care basket. There would no longer be additional insurance but only additional insurance for services that do not fall under solidarity, such as medicines reimbursed today at 15% or 30%, so-called comfort care or even excess costs. fees.
This was the project defended during Emmanuel Macron’s first five-year term by both Didier Tabuteau, today vice-president of the Council of State, Pierre Louis Bras, former president of the Retirement Orientation Committee (COR), and Martin Hirsch, former director of AP-HP (Assistance publique-Hôpitaux de Paris).
It would therefore not be a question of restricting access to long-term conditions (ALD) covered at 100% of the regulated rate, as Bruno Le Maire envisaged, but on the contrary of extending it. The elimination of contributions to supplementary insurance, the cost of which continues to increase (plus 8% to 10% this year), would allow an increase in the general social contribution (CSG) or social contributions much lower than the current amount of contributions paid to the complementary ones.
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