Sick leave: Health insurance calls for consideration of a "more sustainable" system

According to the director of the National Health Insurance Fund, Thomas Fatôme, expenditure on compensation for people on sick leave was once again on the rise (+8%, including work accidents and occupational diseases) in the first half of 2024, and could "exceed 17 billion euros" by the end of the year.

Of course, it is normal for sick leave expenses to increase each year, due to demographic factors - changes in the working population, ageing of the population - or economic factors - increases in the average salary or the minimum wage, for example.

But according to the Health Insurance's calculations, a large part of the recent increase cannot be explained by these criteria alone, and other factors, to be determined, clearly come into play, explains Mr. Fatôme.

"It is an important, difficult, complicated debate", which will undoubtedly affect "the state of health of a part of the population, the living conditions at work" or a "different relationship to work", he said.

In a year where spending increases by one billion euros, as in 2024, "that's 400 million euros" of additional spending unexplained by demographics and the economy, he said.

"Tracking down" fraud

Mr. Fatôme called for "bringing all the stakeholders around the table" (government, Parliament, social partners, etc.) to conduct "a more general reflection" on the system and "make it fairer, more equitable, more readable, more sustainable."

"Depending on the size of the companies, depending on your seniority, you are not covered in the same way" and "many insured people say that they have difficulty understanding how they are covered", he explained, saying that he was "at the disposal" of the future government to contribute to this work.

Pending in-depth discussions, Health Insurance will "relaunch" and "expand" the "range of actions aimed at policyholders, businesses and prescribers" which, in 2023, allowed it to cut 200 million euros from the increase in expenditure, he explained.

It is a question of both "tracking down" fraud and "supporting" patients and prescribers to improve practices, he added.

The Cnam will therefore massively address social security beneficiaries: it will contact "all those insured on sick leave for more than 18 months", i.e. 30.000 to 40.000 people, to "check whether the sick leave is still justified" or whether it is possible to adapt it with, for example, "therapeutic part-time work", or "an organized return to work", explained Mr. Fatôme.

Some insured persons will be reminded of the rules by mail, such as the obligation to stay at home during working hours, and the Cnam will contact "7.000 general practitioners who have fairly high prescription levels", for a "fraternal exchange" with a medical advisor in order to "understand" and "see if they can contribute to better control of expenses", indicated Mr. Fatôme.

"Sick" work

On the other hand, Health Insurance is not for the moment renewing the controls and constraints (setting objectives, prior agreement) which so exasperated doctors last year.

The Cnam will finally organize visits to a thousand companies with high absenteeism to check whether they are not creating "the conditions" for these work stoppages or accidents.

Health insurance is starting to roll out tamper-proof work stoppage prescription forms, which will become mandatory from June 2025.

Faced with the position taken by the Health Insurance, the Unsa union stressed that it was necessary to "stop stigmatizing the sick".

"It is illusory to think that substantial savings will be made on work stoppages without tackling the root causes: more serious and more numerous illnesses, longer careers with the increase in the retirement age and constantly increasing psychosocial risks," said Dominique Corona, deputy general secretary of the union.

It's not the doctors who are abusing, "it's the work that is sick", said CFDT Secretary General Marylise Léon on France Inter on Sunday.