At the end of a turbulent and lengthy process, France’s 2025 health budget has finally been approved. This “imperfect” budget resulting from months of debate in a parliament with no absolute majority does not embrace the more radical cost-cutting measures originally proposed. It does raise funding for hospitals by EUR 1 billion. But with a healthcare deficit set to reach a record EUR 22 billion+ in 2025, is this new budget enough to save France’s ailing healthcare system?
A Less-than-Perfect Compromise
France’s Social Security Financing Bill (PLFSS) governing healthcare spending for 2025 was finally approved last week. The vote in favour of the budget concluded a budgetary process that dragged on for months and comes after the state budget for 2025 was also definitively adopted earlier this month.
With no clear majority in parliament, the health budget was initially proposed in October under Michel Barnier’s government. To avoid the fate of the previous Prime Minister who lost a vote of confidence over budget disagreements, the Bayrou government has tinkered with it since January. “We have taken note of the priorities expressed to propose a text that is probably imperfect,” said Catherine Vautrin, the minister for Labour, Health, Solidarity and the Family, after these adjustments were made.
Several concessions were brought forward to please the strong left-wing alliance, including giving up on a plan to increase patients’ out-of-pocket payments after health insurance reimbursement. The proposal to re-evaluate retirement pensions based on inflation has been eliminated as well as the proposed “solidarity contribution through work” that involved employees providing 7 hours of unpaid work to finance the growing costs associated with an ageing population.
The final 2025 budget commits EUR 666 billion to expenditure, 3.7 percent more than in 2024. Notably, the envelope allocated to hospitals rose by EUR 1 billion and the funds for elderly care homes were tripled.
The budget may have reached the finish line, pushed through perhaps out of necessity, but it is still considered deficient by many. “It was essential to adopt this PLFSS, even if it is imperfect’, said the chairman of the Social Affairs Committee Philippe Mouiller.
Generating Revenues and Cutting Costs
Now that most of the money-generating schemes from the initial version of the budget have been axed how will France’s deficit-ridden public health system drum up the revenues to cover its costs? There are some proposals in the new budget designed to raise revenues that did make the final cut.
Namely, the tax on soft drinks and sweeteners has been increased, as has the tax on gambling, which together are expected to bring in EUR 400 million. Employer’s contributions to social security have also been raised to the level in force a few years ago, which should bring in almost EUR 0.5 billion.
Patients are going to be forced to become more responsible and somehow penalised for not keeping their medical appointments, a measure aimed at savings, yet the details of what this will entail have not yet been established.
The new budget also includes several provisions to combat fraud to save the system further costs. These include speeding up the creation of digital applications for users to request a social security card, reinforcing checks on pension payments abroad, and banning sick leaves taken via digital platforms.
Despite these measures, the absence of new provisions on the revenue front to improve the budget balance remains obvious. “The result is largely insufficient,” complained the socialist senator Annie Le Houérou.
Deepening Deficit
As debates over the new budget raged, the social security deficit worsened and is currently estimated at EUR 22.1 billion. The hole in the healthcare system’s finances is expected to continue growing, topping 24 billion by 2028 as the government grapples with healthcare expenditure arising from an ageing population.
Most agree that the current budget is not sufficient to confront the social security system’s deficit of which healthcare accounts for 60 percent, or the more deep-seated issues that have plagued France’s healthcare system for some time. “We obviously need to do more to reduce the deficit … Otherwise, it’s a time bomb for future generations,” warned Élisabeth Doineau of the centrist union.
Both the left-wing opposition and the groups committed to the centre-right base supporting the government agreed that the social security system needs structural reforms and should be managed with a multi-year strategy. “The ‘sticking plaster’ policy can no longer continue,” said the health sector speaker connected to the centre-right Republicans Corinne Imbert. “We need to have a real debate in the coming months on the financing of our social model. This situation cannot go on,” insisted senator Xavier Iacovelli of president Macron’s centrist Renaissance party.
Healthcare professionals remain sceptical about the new budget and its capacity to solve the problems embedded in the system such as ongoing staffing shortages and the areas of the country that have been left with minimal healthcare coverage, or medical deserts. “A budget had to be voted. It secures the system’s operation in the short term, but it clearly doesn’t solve anything in the medium and long term,” complains Jocelyne Cabanal, national secretary of the healthcare workers union, CFDT.
