Health is priceless, but it comes at a cost. The Covid-19 pandemic has shown it again. If exceptional health spending has sharply increased in France, to the tune of 15 billion euros, the decreases in consultations in town halls should limit this increase to 10 billion.
The deficit of the sickness branch of Social Security, which is anticipated at the historic level of 30 billion euros, is mainly due to a fall in revenue both under the effect of the contraction of the wage bill and therefore social contributions (- 7.6%) and the fall in tax revenue, notably VAT (- 8.4%).
The deficit of the sickness branch of Social Security is anticipated at the historic level of 30 billion euros
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These data must, however, be assessed in the light of health expenditure as a whole. Thus, the “consumption of medical care and goods” (CSBM), which covers the smallest perimeter, roughly medicines and consultations in town and in hospitals, represents 208 billion euros of public and private expenditure in 2019.
Likewise, the National Health Insurance Expenditure Objective (Ondam), which groups together public health expenditure (the public share of the CSBM, daily sickness and accidents at work allowances, long-term care for the elderly and people with disabilities in institutions …), initially planned at 206 billion euros, is now estimated at 215 billion euros for 2020.
After having been driven by a proactive development of the supply of hospital care, especially during the post-war boom, since the 1970s and especially the 1980s, health spending has been perceived as a burden that must be controlled, although needs continue to grow especially with the aging of the population.
Finally, same observation if we consider current health expenditure, the largest aggregate used in international comparisons: in addition to the previous items, it includes institutional prevention expenditure (vaccines, screening) as well as management costs. of the health system, and amounted to 276 billion euros in 2018. In short, be careful to look at the figures, all the figures.
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With the exception of the United States, which is in the lead, France is, among the member countries of the OECD, the one that devotes a significant portion of its gross domestic product (GDP) to health, at 11.2 % in 2018. However, if we look at the share of public money spent on public hospitals, we see that France is behind other Western European countries. And this, despite a health system where the weight of the hospital is regularly considered too great (the famous French hospital-centrism).
Among health spending, it is easy to isolate institutional prevention. It brings together primary individual prevention (vaccination, 3 billion euros) and secondary (screening, 700 million euros), as well as collective prevention on behavior (300 million) and the environment (2 billion). Even by adding other actions carried out over time, such as gynecological examinations, France spends little on prevention. Total prevention, with 15 billion euros, represents 5.4% of health spending. Institutional prevention only represents 2.2%.
