With the Covid, health spending has left the familiar shore of day-to-day management economies, to approach an unknown and luxuriant land. This is evidenced by the Social Security budget for 2022: excluding Covid, compared to 2019, health expenditure is up by nearly 30 billion.
No savings will be made this year on the hospital, contrary to what was practiced before the crisis, when the health branch had to save each year more than 4 billion per year on the trend. On the contrary, an investment and debt recovery plan of 19 billion euros has been initiated.
Of course, the context is unique. The epidemic is not quite over, and there is a social consensus on the need to support the health system. Moreover, 2022 is an election year, which does not encourage any immediate tightening of the purse strings.
Nevertheless, it’s a safe bet that the health plane policy will be less well tolerated over the next five years than it has been for a decade, when the priority was to straighten out Social Security. In this new world, we will probably have to relearn how to make political choices to give ourselves the means to invest.
The cost of health sovereignty
Indeed, society is aging, with chronic and polymorphic patients, and care that costs more, for a long time. We must also rearm public health to deal with emerging diseases Covid-style – no one doubts this after the life-size demonstration of our vulnerabilities. This implies, for example, securing sanitary stocks, or even production capacities on national territory; but this has a cost.
In addition, it is necessary to finance the therapeutic revolutions in progress, on the side of treatments with messenger RNA (which is not only used to manufacture vaccines) or gene therapies, on the side of medical devices, doped by artificial intelligence , connectivity and robotics.
The savings on the drug are getting tougher
The government has promised pharmaceutical companies an average increase of 2.4% per year in spending on health products for three years, instead of 1 to 1.5%. In 2022, it will be 1 billion. The time when the drug weighed 15% of the total expenditure but 50% of the savings seems over, at least for a few years.
Finally, the “Ségur de la Santé”, with more than 10 billion in permanent salary increases, will not be a balance of all accounts on the attractiveness of the health professions. With or without a freeze on the hospital public service, we will have to continue to invest in careers and working conditions if we do not want hospitals and nursing homes to empty. And offer training and retraining to overcome the growing shortage of doctors.
In this inflationary universe, the search for fair care and relevance must more than ever guide the management of public health insurance expenditure. But with the obligation of more structuring reforms of the medical offer (delegation of tasks between caregivers, local organizations bringing together hospitals and liberal medicine, etc.), in order to fight, also, against the difficulties of access to care.
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