The “good but could do better” of the Court of Auditors on the finances of the Social Security

The magistrates of the rue Cambon welcome the improvement in the results of Social Security but point the finger at the growing weight of the deficit of Health Insurance. Structural reforms are necessary to hope for a return to equilibrium by 2019 and no longer 2020.

There is better, but the whole is still fragile. Once is not customary, the Court of Auditors sends, in its annual report made public this Tuesday morning, a satisfaction to the government for the improvement of the accounts of the Social Security in 2015. While issuing – we do not remake – some reservations. “The trajectory is going in the right direction, thus declare the magistrates of the rue Cambon. Yes, there is a recovery, but at the cost of opportunistic adjustments. Above all, we cannot be satisfied with a situation where the health insurance deficit remains very significant ”.

It prevents. The Court of Auditors confirms the trend for improvement. While stabilization was expected,. A level which remains however clearly higher than that recorded before the beginning of the crisis, namely a hole of 9.3 billion in 2007. This figure is concentrated on the “shoulders” of the branch Health insurance and the FSV, the public establishment which finances minimum old-age allowances and other retirement benefits under national solidarity.

The deficit of the FSV – of which the government never says a word, preferring to focus its analyzes on the general regime alone – continues to increase: it went from 3.5 billion euros in 2014 to 3.9 billion. in 2015. As for Health Insurance, the “big patient” of Social Security, its hole amounts to 5.8 billion euros (against 6.5 billion in 2014). In 2015, it represented 85% of the deficit of the general system and could constitute, according to the financial magistrates, “almost all” for 2016. “Health insurance must be a priority, just like pensions. We must not relax our efforts and, on the contrary, redouble them ”, affirm the Wise Men.

In this regard, this year “will be marked by an improvement in the deficit”, anticipates the Court of Auditors. But not as clear as and that provided by the Social Security Accounts Commission (CCSS). At the time, the CCSS had forecast a deficit of 9.1 billion for 2016 but this forecast includes “in a questionable way” an exceptional product of CSG for 700 million euros. “This amount is only accounting creativity and has no financial reality. We recommend neutralizing it, ”therefore explains the Court of Auditors.

Dentists in the sights

According to financial magistrates, the deficit of the general regime and the FSV should therefore be reduced by some 400 million to drop below the 10 billion mark in 2016, to 9.8 billion precisely. And this, Therefore, the return to balance of the accounts of the Social Security would be done in 2020, one year ahead of the schedule envisaged last year by the Court. Even in 2019 if, by a miracle, additional savings efforts are made, in particular on health insurance. “Structural reforms and not just one-off adjustments”, specifies the Court of Auditors, thinking of “the harmonization of the bases of user fees (part of health expenditure which remains the responsibility of patients after the Health Insurance has reimbursed its share, editor’s note) between all public and private health establishments “, or the adoption of” more restrictive measures to limit the rates of excess fees “or the extension of” measures to limit the remainder payable by households ”.

Precisely, on the subject of the “remainder of the household responsibility”,. Two days before the opening of negotiations between Health Insurance and dentists, the Wise Men have formalized their grievances against a sector they denounced. With the withdrawal of health insurance (33% of health expenditure in 2014 against 39% for complementary), the remainder payable by social insurance (25% of expenditure) remains very high. This pushes some patients to give up seeking treatment. “The new convention will be the last chance. In the event of disagreement, it will be necessary to review the method of covering expenses, ”concludes the Court of Auditors for which the Health Insurance must cover lighter preventive and maintenance care and additional, heavier care. (prostheses, orthodontics, etc.). , it is a new showdown that is announced for the Minister of Health.

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