The National Health Insurance Fund (CNAM) has published figures summarizing expenditure on sick leave. They are increasing sharply.
Thomas Fatôme, the general director of the National Health Insurance Fund (CNAM), is seizing the upcoming period of budgetary tensions. While the pension issue has been widely discussed since the dissolution, the CNAM is drawing attention to the increase in health insurance spending on sick leave. The manager is already warning that the deficit forecast at 11.4 billion will be exceeded, and that these sick leave are weighing heavily.
According to figures released today, the CNAM highlights that daily allowance expenditure increased from 10.4 to 15.8 billion euros between 2015 and 2023, excluding covid-19. “City care” is progressing rapidly in the ONDAM (National Health Insurance Expenditure Objective), the branch ceiling – it increased from 12.5% to 15.1% over the same period.
In detail, logical factors explain part of the problem: inflation has increased the minimum wage and salaries, and therefore compensation. On the other hand, the population is aging, so people receiving compensation are “better paid and more often affected by work stoppages,” explained Thomas Fâtome during a press conference organized this Monday.
But a large part of the increases are not justified at first sight. 42% of the growth in expenditure is attributed by the CNAM to an “effect of recourse rate and duration”. Understand: the French are more often stopped than before, and for longer.
“This is where the question of living conditions, the state of the working population and fraud arises. If annual expenditure increases by a billion euros per year, 400 million are not linked to economic factors,” explains Thomas Fatôme.
Doctors control
The CNAM wants to be reassuring by estimating that its measures taken in 2023 have already borne fruit in slowing down the dynamics. In terms of volume, sick leave increased less (1.8%) last year, and the fund estimates that it has recovered 150 million euros from doctors. “Brotherly interviews”, which the CNAM explains are not checks, would have made it possible to reduce by 6% the sick leave issued by the doctors met.
Second item of savings, the insured themselves (for 40 million euros saved) – the CNAM carried out checks (1.2 million) which resulted in half of them getting in touch with a doctor and doing a check, and in 1 case out of 5, in summonses to check the patient’s state of health more precisely. Those who had been on sick leave for more than 18 months were also checked.
On the business side, the CNAM recovered 35 million euros by identifying atypical companies in terms of the number and duration of sick leave – and by registering them in prevention programs. Finally, fraud remains very much in the minority – 8 million savings achieved – and is largely based on the falsification of paper Cerfa files, which are set to disappear with digitalization.
The urgency is high: the CNAM estimates that sick leave expenses are increasing by around 5.2% per year. They are only exceeded by health products (6.3%).
