Health insurance: Court of Auditors points to “opaque” transfers masking ill health
The Court of Auditors highlights the ill health of health insurance
The Social Security deficit has reached its lowest level since the crisis of 2008, but the deficit of the disease branch remains worrying, according to the Court of Auditors who is surprised by “opaque” transfers used for its recovery.
In 2016, the overall security deficit continued to fall to 7.8 billion euros, becoming for the first time lower than that of the pre-financial crisis of 2008, notes the Court of Auditors in its report annual report on the Social Security budget published on Wednesday.
A decrease in the continuing deficit since the peak of 2010 where it had reached 29.8 billion euros, testifying that “the actions undertaken are achieving results,” highlight the magistrates of Cambon Street.
Evolution of the cumulative deficit of the general scheme and branches of Social Security since 2012
However, “the financial situation of the Social Security is not yet sanitized, as illustrated by the announcement of the government of a new discrepancy, from 2019 to 2020, of the objective of balance,” said the president of the Court of Accounts Didier Migaud at a press conference.
He noted the “significant transfers of the State” which brought “nearly 4 billion euros of resources, even though its own deficit widened”.
The financial situation remains “marked by a very high deficit, the reduction of which is actually lower than shown, and which is increasingly concentrated on health insurance and old-age insurance,” Mr Migaud insisted.
The return to equilibrium of the disease branch, which accounts for two-thirds of the deficit, is “a major priority”, urges the Court in its report.
“The deficit reduction” of Health Insurance is also obtained through “opaque” transfers from other branches, notes the Court of Auditors
However, its deficit of 4.8 billion euros in 2016 is virtually unchanged from 2015 if an exceptional product of CSG of 740 million euros is taken off “which should not have been entered in receipts “. The “hole” would actually reach 5.5 billion euros against 5.8 billion in 2015, according to his calculations.
“Minor deficits” of the Health Insurance are also obtained through “opaque” transfers from other branches, although they have been financially distinct since 1967, in order to respond to ” posting of pay, “criticizes the Court.
– “Artifices croissants” –
Thus, “since 2015, the largest transfers of income benefit the Health Insurance to the detriment of the old age risk (2.8 billion euros deficit counting the Solidarity Fund old age)” and explain “almost all improvement “of the sector balance between 2014 and 2017, it notes.
Overall deficit and deficit of the general social security system, evolution since 2012 and forecasts for 2017, according to the Social Security Accounts Committee
“It has received in practice the equivalent of 65% of the increases in old age contributions made in the framework of the pension reform of 2014,” she insists.
Transfers of surplus branches to the deficit sectors “would generally reduce the effort to control social spending”, warns the Court of Auditors, which calls for the establishment of “obligations enhanced transparency”.
Meanwhile, compliance with the National Health Expenditure Objective (Ondam) – a mechanism to curb the natural increase in health care spending – for the seventh consecutive year is more impressive than it should be. He was “hit at the price of increasing artifices” that affect “sincerity”.
Spending has actually increased 2.2% instead of 1.8% and is expected to increase by 2.4% in 2017, against 2.1% expected, according to its calculations.
For the Court, however, reforms are possible. In particular, it suggests better control over fees overruns by liberal medical specialists. Spending on health insurance for the latter is in “strong increase”, while “inequalities” in access to care “are strengthening”.
The President of the Court of Accounts Didier Migaud on his arrival at the Hotel Matignon in Paris, June 29, 2017
She points to the “limited and very costly results” of access to care contracts (CASs) designed to limit doctors’ overpayments: “In 2015, to avoid a euro of overrun, the Health Insurance has spent ten “.
“In the overdouched areas, only specialists of sector 1 (without overruns of fees) should be able to settle,” pleaded Didier Migaud.
Also targeted are distribution costs, which “constitute an important but largely unrecognized part of the cost of medicines”.
To the regulated remuneration paid by the Health Insurance to pharmacies, there are additional fees paid directly by pharmaceutical companies and wholesalers to pharmacists valued at 2 billion euros.