the reforms will not be enough to fill the hole in social security, warns the Court of Auditors

In 2023, the Social Security deficit should stand at 8.2 billion euros, according to government forecasts. After a deficit of nearly 20 billion in 2022, the accounts appear to be in sharp recovery. The Court of Auditors does not, however, congratulate the executive. The decrease in the deficit is explainedmainly due to the decline in health insurance expenditure linked to the health crisis“, indeed advances the institution in its latest report on the application of the laws of financing of social security, published this Wednesday. More worryingly, from 2024 the famous “hole” of Social Security should start to rise again due to “the growing deficit of the old-age branch and the increase in health insurance expenditure, despite the recently adopted pension reform”. The Court is thus counting on a stabilized deficit of around 15 billion euros in 2025 and 2026.

First cause for concern, the old-age branch showed a shortfall of 3.8 billion euros in 2022, due to expenditure increasing by 5% over one year. This development can be explained by the two increases in pensions implemented last year, in response to inflation. The pension reform adopted last April, considered so violent by its opponents, will not alone restore the balance of this branch, warns the Court of Auditors. “By taking into account the effects of the reform and the regulatory measures [de hausse des cotisations, NDLR]the deficit of the old-age branch and the old-age solidarity fund would reach 5.7 billion euros in 2030“, write the authors of the report.

The wise still observe with anxiety the drift of health expenditure, framed by a national objective of health insurance expenditure (Ondam), which has been set, for 2022, at 237 billion euros. An objective exceeded by more than 10 billion euros due tothe continuation of the health crisis for 6.8 billion euros, compensation paid to health and medico-social establishments for 3.4 billion and the drift of certain expenses for 1.5 billion (health products, daily allowances)“, according to the report.

In the budget documents, the State has included a very ambitious growth target for Ondam, limited to 2.9% per year. “In the past, never such moderation could be obtained over several years“say the authors. The implementation of this trajectory would require a set of reforms aimed at “improve the efficiency and quality of cares”, write the magistrates again citing “medicalized control of health expenditure or medical imaging“.

An extension of the life of Cades?

Under these conditions, Acoss, the organization which manages all the resources of the general social security system, will not be “no longer able to finance, on its own, the deficits of the general scheme for the 2024 and following financial years, nor the cumulative deficits of the CNRACL [le régime spécial de la Sécurité Sociale chargé de l’urance vieillesse des fonctionnaires territoriaux et hospitaliers, NDLR] since 2020“, worries the Court which evokes the hypothesis of a further extension of the life of the Social Debt Amortization Fund (Cades) beyond 2033. “ To do this, a multi-year reform program must be established, accompanied by a trajectory for restoring the accounts“, plead however the magistrates.

The Sages have no shortage of savings ideas to include in this possible program. They thus recommend re-establishing an “alert threshold” in the event that the Ondam exceeds 5%, tackling the issue of overruns through regulation, beefing up the financial indicators of all health establishments, “to further modulate the types of intervention of urgent medical aid according to local needs», to strengthen the fight against social fraud by deploying automated controls, to consolidate patient medical data at the national level or to make electronic prescriptions mandatory…