National Health Insurance Fund aims for “1.56 billion in savings” by 2025

Around thirty proposals are being studied to achieve significant savings, in particular the fight against sick leave fraud.

The National Health Insurance Fund aims “1.56 billion euros in savings in 2025”she explains in her report “Charges et Produits pour 2025” approved Thursday July 18 and which France Culture was able to consult. The Cnam expects to record a deficit of around “11.4 billion euros in 2024 (…) despite a clear recovery in 2023″.

To achieve significant savings, around thirty proposals are being studied, in particular the fight against fraud and abuse, estimated at “420 million euros”optimization of care pathways (1.06 billion euros), better prevention of chronic pathologies (80 million euros) and the “hunt for waste”.

The Cnam thus sets itself the objective of strengthening the fight against fraud in work stoppages. In 2023, the health insurance medical service checked 1.2 million work stoppages and visited 336 companies with more than 150 employees. These checks made it possible to detect a loss of 17 million euros wrongly paid out, according to information from France Culture. To better detect these false stoppages, the Cnam will create tamper-proof forms “from the start of the 2024 school year” and gradually by June 2025. “This new form [sera réalisé] with tamper-proof, specific paper that can be differentiated from a photocopy of a traditional Cerfa form”promises Thomas Fatôme, director of health insurance, on France Culture.

A service called “SOS IJ” will also be created for “helping doctors in their prescriptions of sick leave in complex situations”. Thomas Fatôme recalls that “medical advisors, social workers and administrative staff” health insurance are available to answer any questions doctors may have regarding the increase in requests for sick leave. This involves, for example, supporting doctors who “have trouble saying no” has “repeated requests for sick leave from the same patient” or in the case of a long stop to see “if there is a need to connect with social services” Or “trigger a disability”.

Another avenue studied by the Cnam, “the hunt for waste of health products”To do this, health insurance teams have “worked with doctors, nurses and pharmacists”explains Thomas Fatôme. The general director of health insurance gives the example of “waste of bandages”. “It may seem anecdotal, but we spend no less than a billion euros each year on covering dressings, and we can use this money better.”he assures. He notes that “in doctors’ surgeries, in nurses’ offices and in the medicine cabinets of the French, tons of bandages are not used”.

To avoid ending up with significant waste, the Cnam thus proposes that in the case of a “long-term medical prescription of dressings”, “the intervention of a nurse after seven days”in order to check whether the patient has “need the prescribed number of boxes” and eventually “adapt this prescription”.

Finally, the Cnam also wants to improve early detection and prevention of certain pathologies such as cardiovascular diseases through “a global, patient-centered approach”. Health insurance advocates for “systematize annual screening of people at risk” and organize “systematic screening of cardiovascular risk for postmenopausal women”The Cnam also deplores an increase in violence against women in recent years and therefore proposes to “support the development of Women’s Houses, dedicated to reception and care” of these women victims of violence.