The Court of Auditors offers “a diagnosis of the major challenges of the coming years” as well as “levers of action that can be mobilized to respond to them”. In a series of reports published Tuesday, December 14, the court chaired by Pierre Moscovici analyzes the “structural issues for France”. Health insurance, industry, culture… What issues does the Court of Auditors identify in this series of studies, and what solutions is the institution putting forward? Franceinfo reviews the main points of its conclusions.
In terms of health, the need for “financial equilibrium”
The note from the Court of Auditors on health insists on two imperatives: “guarantee access to quality care and reduce the health insurance deficit”. But it is mainly about the second part in this document. Indeed, “structurally, the financial equilibrium of health insurance is affected by the effects of the aging of the population and by the expansion of chronic pathologies on health expenditure”, start the report.
For the financial jurisdiction, “the impacts of the health crisis on social revenues”, as well as recent “increases in remuneration (…) decided in particular within the framework of the Ségur de la santé agreements, risk exposing health insurance to deep and lasting deficits”. The Court of Auditors has identified levers in four areas in which it sees “efficiency margins” and therefore opportunities for savings: “the organization of care, the remuneration of health actors, the avoidable causes of expenditure and the contribution of digital technologies to the transformation of the health system.”
According to the Court, between 4.5 and 6 billion euros in savings will indeed be needed each year to “bring health insurance back to financial equilibrium before 2030”. The court proposes, for example, to reduce the 30 French CHUs to “About ten”, or from “weigh on the prices of medical devices”, criticizing the “high level” profitability of private dialysis centers. It also calls for putting a stop to “wrongly reimbursed health costs”, by blocking “a priori a greater number of irregular invoices”.
In addition to these savings, the authors of this report estimate that “the taxation of alcoholic and sweet drinks should be raised”. They plead for “specific taxation” on processed food products with a high added sugar content.
In education, the observation of “mediocre” performance
Despite 110 billion euros allocated to primary and secondary education in 2020, “national spending on education above the OECD average”, “the performance of the French school system tends to deteriorate, in particular for young people from disadvantaged backgrounds”, warns the Court of Auditors in its report on education.
The administrative court considers that the rebalancing of resources in favor of the first degree, “priority for educational success” and the adaptation of expenditure to changing demographics are still “slow”. Successive reforms, focused on the students’ curriculum, “are not enough to improve performance”, further evoking a system “overly centralized and supervised management”.
“Educational reforms need an overhaul of the organizational methods of the school system, affecting in particular the autonomy of schools and the prerogatives of school heads.“
the Court of Auditorsin a note on the school
Among its proposals, the institution evokes links between schools and colleges “to facilitate the student’s journey”, Where “more margins of autonomy” for establishments. “The framework for exercising the teaching profession should be overhauled, with better consideration of assignments outside the classroom (…) or short-term replacement solutions to be found”, continues the Court of Auditors.
Finally, “improving the performance and equity of the school system requires a stronger ability to adapt to local contexts and student profiles”.
The professional integration of young people remains “difficult”
Even though the devices are “many”, “the professional integration of young people remains difficult in our country and their path to employment uncertain and troubled“, regrets the Court of Auditors. It notes that the measures for the professional integration of young people are not sufficiently targeted towards the people most in difficulty.
The bonus for the exceptional hiring of an apprentice, from 5,000 to 8,000 euros depending on age, was thus awarded “regardless of the level of qualification”. The development of apprenticeship, with entries increasing from 289,000 in 2016 to 525,600 in 2020, “took place at the cost of a widening towards higher educational levels”, she points out. However, this choice does not improve “that at the margin the integration into the labor market of the most qualified young people, moreover already good”, while leaving aside young people further removed from employment.
On the youth guarantee, the Court of Auditors regrets that the choice of this support system is “often mainly guided by the motivation of the young person and by his financial difficulties, and not by the objective scale of the difficulties which he is confronted”.
French industry lacking innovation
The Court of Auditors considers that “research and development is insufficiently translated into industrial innovations”, in his note on industry. “The industrial fabric is marked by the preponderance of large groups whose internationalization strategies, unlike other European countries, do not favor the production of goods from France, while small and medium-sized enterprises and companies of intermediate size struggle to develop “, continues the document.
The institution also highlights taxation in French industry, with “the highest effective tax rate on non-financial businesses in the EU”. Another problem: the rate of decarbonisation of industrial players, of the order of 1.4% per year between 2013 and 2019, “insufficient to achieve the objectives” planned to align with the Paris agreements.
Faced with these issues, the court advises, among other things, to “better manage industrial policy, which must be better coordinated with energy, research and innovation policies and sectoral policies such as health”. It is necessary in parallel “support industrial policy on European funding and cooperation projects, to keep the EU at the technological frontier”. It also seems to him necessary to“register the responses to the challenges of digital transition and the decarbonisation of French industry over time at national level, and within the framework of coordination at EU level”.
In culture, problematic “management”
The court notes “a tremendous expansion of cultural activity in our country”, but French policy in this area is “marked by the multiplication of operators of the ministry, who took advantage of their autonomy to develop in a remarkable way”, she continues in her note on the subject.
The ministry, whose budget exceeded 3 billion euros in 2020, was “in a way a victim of the success of the project of which he was originally the bearer”, with a “profusion” of the offer facing which he finds himself in a position to distribute “grants”. The Court of Auditors mentions “massive public funding” for the performing arts, which “led to an overabundant supply, therefore to an imbalance between creation and distribution”. “We are also seeing a sprinkling of aid according to a one-stop shop and acquired rights policy, which is difficult to question.”
Faced with this observation, “a global review of the missions that fall to the ministry to assume” seems necessary, in order to “refocus the Ministry of Culture on its missions of impetus and steering”.