Still not out of the Covid, the National Health Insurance Fund (Cnam) maintains a savings target half the two billion targeted each year before the health crisis – out of a total of around 230 billion in expenditure.

A sign of the executive's new priorities, its traditional "expenses and products" report for 2023 gives pride of place to prevention - now attached to the title of the Ministry of Health.

The Cnam places particular emphasis on heart failure, with a general public information campaign on "warning signs" from the end of September and the desire to generalize remote monitoring to the 300,000 most "severe" patients. .

Remote monitoring is also promoted for diabetics, in order to avoid complications related to the disease, via digital tools (apps, connected devices) or the Sophia telephone support service.

Health Insurance also wishes to make up for the delay accumulated over the past two years in terms of cancer screening (colon, breast, uterus) and the vaccination of adolescents against the human papillomavirus (HPV), even if it means sending doctors the list of their affected patients.

Other proposals echo Emmanuel Macron's campaign promises, such as "systematic identification of visual and language disorders for all 3-year-old children" - the re-elected head of state referred to "early detection of differences in development", without specifying at what age.

If this bet on prevention is supposed to "bring long-term effects" (the gain of the 2017-18 anti-influenza campaign is thus estimated at nearly 50 million), these new approaches "by pathology" or "population-based" do not represent however only a minority (160 million euros) of the savings projected for 2023.

– Tight negotiations –

The big chunk (750 million) targets as usual drugs (fewer antibiotics, more biosimilars), medical devices (sleep apnea, dressings), work stoppages or even medical transport.

An increased effort against fraud and abuse of caregivers (300 million) is also announced, with better "invoicing control" and new "actions against deviant dental centers".

The review of "damages", started in the spring with a particular focus on nurses, must continue with other estimates on pharmacists, physiotherapists and doctors expected by the end of the year, among others.

In the meantime, Health Insurance is taking advantage of its annual report to lay down some milestones before a series of tight negotiations.

The “high” margins of biological analysis laboratories, boosted by the health crisis, are thus put forward to justify a renegotiation of prices at the start of the school year.

Same calendar and same method for dentists: wishing to extend the "100% health" to orthodontics, the Cnam highlights the overruns of fees and the income of the professionals concerned.

Ditto for doctors, who will have to overhaul their agreement with Social Security: their income, but above all the growing cost of their prescriptions are analyzed in detail.

In return for new "delegation of tasks" to paramedics and "advanced consultations" of specialists in medical deserts, the fund is however ready to grant practitioners an extension to pay more medical assistants and solve the problem of 6 million insured without attending physician.

But in the end, the recommended treatments will not cure Health Insurance of the deep ill of the deficits dug by the Covid: after the abyssal records of 2020 (-30 billion) and 2021 (-26 billion), the losses should still reach 19 billion this year and stay at more than 13 billion next year and beyond.

A new austerity cure seems excluded, the remedy still remains to be invented.

© 2022 AFP