A worsening economic situation, a recovery that needs to be implemented
Despite extraordinary expenditure related to the health crisis (screening tests, vaccination) higher than expected, the social security deficit fell sharply in 2021 (24.3 billion EUR compared to 39.7 billion EUR in 2020), thanks to the recovery of the economic activity, but also due to the recognition in 2021 of income from social contributions relating to 2020 (5 billion EUR). In 2022, the deficit will shrink again (to nearly €18 billion), but its reduction will be solely attributable to the fall in spending related to the crisis, which is again underestimated. Revenue growth would be completely absorbed by the dynamics of non-crisis spending.
In 2023, the deficit should continue to decrease (to almost EUR 7 billion), but the costs of health insurance, especially those linked to the crisis (forecast EUR 1 billion), may be underestimated. From 2024, the deficit should rise to almost 12 billion euros in 2026, despite optimistic economic assumptions – an attempt to control the cost of health insurance, which would be reinforced compared to before the crisis, and a new reform of retreats. The retention of the social security deficit creates the risk of a continued growth of the social debt (approximately EUR 160 billion expected by the end of 2022) to the detriment of future generations. The court proposes various changes to the structure of the financing of the various branches of social security and notes that the liberal health professions must contribute more to the collective effort to control health costs.
Necessary reforms, issues that need better consideration
The Court focused on four issues which highlight the need for reform. The medical imaging sector, which is developing under the influence of the arrival of innovative techniques, suffers from hospital activity in increasing difficulties due to radiologists’ increased preference for liberal practice and unequal territorial distribution. Regarding radiation therapy, which treats half of new cases of cancer each year and represents a cost of 1.5 billion € for health insurance, the terms and conditions for pricing activity in hospitals and in private practice should be harmonized – the same care is delivered there. Another priority issue: the medico-social sector, which has one of the highest occupational accident rates of all activity sectors, in a context with too low a supervision rate. The court makes several recommendations aimed at reducing the frequency of occupational accidents and occupational diseases, increasing the attractiveness of the sector and improving the quality of service provided to users. Finally, it recommends a reform of entitlements to compensate, especially for mothers, the impact on pensions of interruptions in business life in connection with the birth and education of children.
Recent initiatives with mixed results
The third part of the report takes stock of two recent measures. The court examined two mechanisms for childcare benefit (Paje): noting that the first of these mechanisms (the shared childcare benefit, which compensates for periods of inactivity to educate the child in its first three years) has failed to achieve its objectives, recommends The right to have the amount reassessed and its duration of payment limited to the child’s first year. With regard to the supplement for free choice of childcare (CMG), which helps families finance childcare for children under six years of age from a third party, the Court finds it necessary to restructure the scales so that the poorest families can make greater use of all external childcare arrangements. The court also takes stock of the implementation of the complex reform of housing benefit, which since 2021 has been calculated on the basis of more contemporary income. If the pooling of resource data between and within the tax and social spheres should make it possible to manage benefits better, it is necessary to simplify the very definition of the resources to be taken into account. Finally, the Court assessed the transfer to the general scheme for the administration of social security for the self-employed, which it considers to have been successfully implemented, although better consideration should be given to some of their specific needs. However, it emphasizes that the collection of their social contribution must continue to be a central point of attention.