Are doctors prescribing too much sick leave?

As the budget review approaches, it is not surprising to see the return of the debate about the “security hole” and the ways to fill it. Asked by Les Echos at the beginning of September, the head of the National Health Insurance Fund (Cnam) Thomas Fatôme had his own opinion on the question:

“In 2024, expenditure related to work stoppages will increase by more than 1 billion and is now around 16 billion euros, which is huge. Demographic and economic factors do not explain everything. The system lacks safeguards. »

In order to “control the cost of work stoppages”, several actions will be put in place, he announces, including meetings to discuss policymakers who will benefit from long leave. Even if the term is not clearly used, the “hunt for utility judgments” – which had already begun a few months ago – follow up.

And like every year, the controversy is growing regarding the number of people who would be arrested a little too easily. The figure of 30% of unprovoked stops mentioned by the Cnam director was repeated in the media. But be careful, this is 30% of a sample of 270,000 policyholders who had repeated work stoppages, said Thomas Fatôme himself.

“One out of three stops is not a problem! warns Nicolas Da Silva, a researcher at the Center of Economics of the University of Paris 13, also columnist for Economic alternatives. Health Insurance didn’t pick the accounts by chance, it targeted those with doubts. »

More controls, less revenue

This does not mean, of course, that there is no sick leave without reason, but they are still in the minority. According to the Court of Auditors, the amount of fraud in daily allowances (sicknesses, occupational accidents and occupational illnesses, maternity and paternity) detected by Health Insurance reached 12.8 million euros in 2022.

“Health expenditure in France, in contrast, represents 313 billion euros. No one is saying that we shouldn’t fight fraud, but it is hard to believe that fraud is a source of significant savings.follows Nicolas Da Silva.

Especially since he says, it’s not patients who order sick leave for themselves. The demand for health is encouraged, it is the doctors who make the decisions.

So, do some people tend to sign work exemptions a little too easily? The Cnam has at least announced that there are 7,000 GPs, who prescribe suspensions “very much”will be notified soon “Considering their habits and seeing if there is a way to better control the situation”dixit Thomas Fâtome.

But this control policy, which has been increasing for several months, is not going down well with users. In March, Jean-Michel Sterdyniak, occupational physician and general secretary of the National Union of Occupational Health Professionals (SNPST), already explained the limits to us : “Some people talk about a convenience stop when there is a difference of opinion between the Health Insurance medical consultant and the attending physician throughout the stop. »

In addition, users can be considered as “excessive prescribers”, and thus be subject to closer control, without taking into account territorial inequalities:

“The level of work stoppages is not the same in Seine-Saint-Denis, where there is a shortage of doctors and a relatively young working population, as on the Côte d’Azur where there is a lot of traffic -retirement and many doctors.” , citing Jean-Michel Sterdyniak as an example.

“There is no evidence that doctors are prescribing too much sick leave”, resumes Nicolas Da Silva, who studied report of the Court of Auditors on sick leave.

“The document is very difficult to show that there is a fair effect. Despite the lack of proof, Health Insurance is still trying to make budget savings on work stoppages because it has to be done somewhere. »

However, another option would be possible. With an increase in costs related to sick leave, it would be possible to increase income. The Court of Auditors has done the calculations: without the contribution exemption schemes – which finance Social Security – the balance of the general scheme would have been positive between 2018 and 2022. A reflection to take into account those who ‘must check soon. Budget 2025.

Structural reasons

In addition, if we indeed see an increase in sick leave, several structural reasons can explain it. First, the increase in wages.

“Daily Allowance (IJ) [que perçoit une personne en arrêt maladie, NDLR.] calculated at 50% of the total salary. However, the minimum wage has increased, just like other wages. Mechanically, the IJs have increased,” explains Nicolas Da Silva.

At the same time, the active population has increased: +2.5% since 2017. And “if there are more people in the labor market, it is entirely likely and expected that more people will be on sick leave”following the economist.

In addition, the general Social Security system has integrated the plans for independents and liberals. “Of course, this union caused additional costs to the general system,” notes Nicolas Da Silva.

Added to this is the aging of the population and the extension of working hours. “The risks of getting sick after the age of 60 are higher than before the age of 30remembers Dr. Jean-Michel Sterdyniak. Older people are likely to get more illnesses, but they are also affected by professional wear and tear. »

Not forgetting that working conditions are deteriorating (intensive work, constant pressure, loss of autonomy and individual work) and that psychosocial risks are affecting more and more people. But instead of dealing with these issues, the public authorities are shaking the stick, continuing to bring the thermometer back…