Health: François Bayrou's budgetary guidelines worry the medical world

The healthcare world is anxiously preparing for the budgetary shock demanded this week by François Bayrou for 2026: healthcare spending contained to five billion euros, an austerity drive unprecedented in recent years. "We have the feeling that we're going to try to make more savings than ever before, while needs continue to increase," laments Daniel Guillerm, president of the National Federation of Nurses, the main union of independent nurses, which has just begun highly anticipated negotiations with the French health insurance system to increase the profession's fees.

According to the targets set by the Prime Minister, the growth in volume (excluding inflation) of health spending (Ondam, national health insurance spending target) will have to be limited to 0.4% in 2026. This represents growth of less than 2% in value (including inflation), which would be well below that observed in recent years, even excluding Covid-related spending.

Between 2019 and 2025, the increase represents an average of 4.8% (excluding Covid), according to figures from the Court of Auditors, with a further increase projected at 3.4% for 2025, to €265.4 billion. And even in 2015-2019, in the midst of austerity measures in health spending - with particularly severe consequences for hospitals - the increase in health insurance spending reached an average of 2.4% per year, according to the same source.

Such a low rate of growth in 2026 "cannot be achieved without extremely concrete measures such as price reductions" for healthcare or "changes in the scope of 100% reimbursements," warns Jean-Marc Aubert, a former senior civil servant and health insurance specialist. "It can't just be about combating fraud or medically controlled spending," he said.

However, François Bayrou , during his presentation of the budgetary effort on Tuesday , did not explain how he wanted to achieve such a brake - five billion in growth instead of the expected ten - on health insurance spending. The Prime Minister gave some examples, but without quantifying them: a tightening of the screws on the long-term illness status (100% reimbursement by Health Insurance of care related to the pathology in question), an easing of the return to work after sick leave for more than a month...

His most concrete proposal is to double the annual ceiling on excesses paid by social security beneficiaries on medications and paramedical procedures to €100 (€1 per package or procedure, €4 per medical transport). Faced with this uncertainty, public hospitals fear a "historically low" increase in their revenue, resulting in "a further drop in hospital fees, which would be unacceptable," according to the French Hospital Federation.

Private practice doctors, for their part, fear that the "conventional system" on fees, particularly those for consultations, signed with the government, will be called into question, according to Franck Devulder, president of the CSMF union. The government has already postponed by six months - until next January - fee increases negotiated in 2024 due to the risk of health spending spiraling out of control in 2025.

Some experts, however, point out that the expected severe austerity measures could be softened if the government were to agree to a slight increase in social security revenues at the same time. "If we want to maintain a level of care similar to that of today, we have to play with revenues," says health economist Nicolas Da Silva.

The expert also points out a fact that is not disputed by anyone: the current deficit in health insurance would be much lower if the government had agreed to raise financial resources (contributions, taxes or duties) to finance the approximately 13 billion in additional expenditure caused by the Ségur de la Santé, the effort to increase the salaries of healthcare workers after Covid.