Work stoppages, medication, medical transport: these expenses in the sights of Health Insurance

2023-06-29 19:32:54

Health Insurance wants to act in all directions to straighten out its finances. It recommends targeting sick leave, medication or medical transport to reduce health expenditure. Enough to generate, in addition to measures to combat fraud and prevention programs, up to 1.3 billion euros in savings next year, reveals a report released on Thursday.

This promises to be watched closely by parliamentarians and the executive, in full preparation of the Social Security budget for 2024. Bercy wants to generate 10 billion euros in savings and has made health expenditure the one of his favorite targets.

Multi-year action plan

To generate up to 700 million euros in savings, the Health Insurance intends in particular to strengthen its vigilance on work stoppages, which have seen their cost increase by 8% over one year to reach 16 billion euros in 2022.

This recent increase can be explained in particular by wage increases against a background of inflation and is linked to the aging of the population. However, the Health Insurance reports an increase in the average duration of sick leave by age group and an increase in the rate of recourse to daily allowances.

Hence its desire to tackle the subject head on via “a multi-year action plan”, likely to release around 230 million euros from 2024. The idea is to target in particular doctors who prescribe judgments, with a “deepening of control and support actions” with “atypical prescribers”.

The subject bristling doctors’ unions, Health Insurance promises “graduated actions”. She also says she wants to target the insured by renovating the work stoppage control strategy.

Disseminate biosimilars

The organization still proposes to provide better support to employers to prevent absenteeism. Proposing to limit to three days the work stoppages prescribed in teleconsultation, the Health Insurance does not pronounce on the other hand on the system of waiting days (without compensation), mentioned in hollow by Bercy during the assizes of public finances and put on the table by the employers in stride.

Among the other expenditure items targeted by the Health Insurance, that of drug expenditure also features prominently. Faced with their increase, it reaffirms its intention to develop biosimilar drugs, generic equivalents for biological drugs.

The objective of distributing these medicines cheaper than their “originals” has not been achieved. Supposed to be at 80%, their penetration rate is only 42%. To accelerate, the Health Insurance proposes to set up a system of “third party payment against biosimilar”, inspired by what was done to distribute generics. In other words, the patient who accepts the substitution of his medication would not have to put his hand in his pocket. The report also proposes to increase the number of molecules that can be “substitutable”.

Rely on third-party payment

While the government wishes to overhaul the drug financing model to respond to the problems of shortages while promoting innovation and reindustrialization, L’Assurance Maladie also suggests targeting the prices of health products “without improving the service medical condition rendered or showing a minor improvement”. More than generating “dry” savings, this should allow money to be reinjected into mature drugs and innovative drugs, the report suggests.

Health Insurance also wants to better control health transport expenses, which cost 5.5 billion euros in 2022. Its idea is to make “shared transport the norm”. The Health Insurance is again relying on third-party payment, to encourage patients to share their repetitive and non-urgent journeys with other beneficiaries of the health system.

Reimbursed physical activity

Beyond these specific measures, the Health Insurance is banking on controls and the fight against fraud and abuse to free up 345 million euros in 2024. This notably involves targeting the practices of certain hearing aid companies. who, for example, charge for equipment different from that which was delivered. It also wants to look into reimbursements for plastic, reconstructive and aesthetic surgery, increase its vigilance with regard to drug trafficking and continue to closely monitor health centres.

Finally, the Health Insurance relies on prevention to avoid unnecessary expenses. It recommends, for example, to better detect diabetes or to open the reimbursement of sports sessions or “adapted physical activity” for patients with diabetes or cancer.