The National Health Insurance proposes 60 measures to optimize healthcare spending and aims for €3.9 billion in savings by 2026

Faced with a concerning financial emergency, Health Insurance has unveiled an ambitious set of 60 measures aimed at controlling and optimizing healthcare expenses in France. In a context where the deficit is projected to reach 16 billion euros in 2025 and could widen to 41 billion euros by 2030 without intervention, this comprehensive roadmap seeks to preserve a solidarity-based and effective healthcare system, while saving 3.9 billion euros by 2026. These initiatives range from promoting enhanced health prevention to strict management of care pathways, including rationalizing reimbursements and implementing tighter controls on sick leave.

The announcement takes place during a critical period where parliamentary debates on the Social Security Financing Bill are expected to be particularly challenging. This determined action by Health Insurance highlights complex but essential levers to ensure the financial sustainability of the system while maintaining quality medical care. The report “Improving Healthcare System Quality and Controlling Spending,” published in early July 2025, lays out a multidimensional strategy with proposals covering prevention, care pathways, and pricing of health services and products, including medicines and the management of sick leaves.

These measures are already the subject of intense debate among parliamentarians and sector stakeholders, particularly on sensitive issues such as capping fee overruns and revising reimbursement to 100% for certain services. A broad consensus remains to be built to turn these proposals into concrete actions, while considering the social and economic importance of Social Security in the French system. The upcoming legislative steps will determine the ability to combine resource optimization with the maintenance of a solidarity-based health coverage, a major challenge for public health and partner mutual societies within this framework.

An alarming financial diagnosis: understanding the stakes of the 2026 Health Insurance report

The “expenses and revenue” report for 2026, recently presented by the National Health Insurance Fund (Cnam), highlights the severity of the current financial situation. With a record deficit of 16 billion euros in 2025, it becomes imperative to understand the dynamics driving this balance toward increasingly concerning figures. Without corrective measures, the deficit could soar to 25 billion euros by 2030, underscoring an unsustainable trajectory for Social Security and mutual societies.

Thomas Fatôme, Director General of Cnam, emphasized during his hearing before the Social Affairs Commission of the National Assembly that this trend is partly related to the “strong structural dynamics” of healthcare expenditures, exacerbated since 2020. The surge in costs related to medicines, uncontrolled sick leaves, and fee overruns illustrates the difficulty in containing financial flows within a sustainable balance. The 2026 report therefore underscores an urgent necessity: both rigorous control and systemic adaptation of expenditure management.

The areas where cost increases are most pronounced include:

• 💊 The annual average growth rate of medication expenses, reaching 4.2% between 2020 and 2024, compared to only 0.6% over the previous decade.
• 🛑 The rise in sick leaves, with accelerated growth since 2019, of which 40% cannot be explained by economic or demographic factors.
• 🏥 Fee overruns in certain medical procedures, notably those related to organized screenings.
• 🔥 The cost of thermal cures, a controversial topic concerning their effectiveness and 100% reimbursement.

To better visualize these trends, the following table summarizes the main expense categories affected:

Expense Category 🔍	Annual growth rate (%) 📈	Share of total expenses (%) 💰
Medications	4.2	22
Sick leaves	3.5	14
Fee overruns	2.8	7
Thermal cures	1.0	1

This financial diagnosis, supported by precise data, forms the basis of the 60 proposals aimed at stabilizing Social Security, closely linked to strategies for improving public health and resource optimization.

Preventive health at the core of proposals to curb rising costs

Health prevention is a major lever in the 2026 report. It is seen as the key to improving the overall health of the population while limiting the increase in expenses. Marguerite Cazeneuve, Deputy Director of Cnam, reminds us that “the only way to prevent the system from losing its sustainability in the long term is for the population to be healthy.” This pillar adopts a proactive approach that anticipates risks before they become costly in care.

Among targeted measures at this level, the following stand out:

• 🩺 The generalization of hypertension screening, a major risk factor for cardiovascular diseases.
• 🍎 The promotion of intensified health education campaigns on lifestyle, including diet and physical activity.
• 🚭 The implementation of financial incentives to reduce smoking and alcohol consumption.
• 🦠 Strengthening vaccination measures, especially against seasonal illnesses.
• 📊 An improved health alert system to better detect and respond to emerging threats.

These strategies are complemented by encouraging mutual societies and health actors to incorporate these preventive practices into their offerings. The system of third-party payment is also analyzed to encourage reducing financial barriers to access preventive care, thus promoting better coverage from the first signs of issues.

A concrete example is the recent hypertension screening campaign in several regions, which enabled early detection of often asymptomatic cases, thus reducing heavy hospitalizations initially planned. This pragmatic approach highlights the importance of preventive measures within an effective health economy strategy.

Prevention Measure 🚑	Expected Impact 📈	Involved Partners 🤝
Hypertension screening	15% reduction in cardiovascular complications	Cnam, general practitioners, mutual societies
Anti-smoking/alcohol campaigns	Consumption decrease of 10 to 20% depending on regions	Government, local authorities, associations
Enhanced vaccination	Reduction in winter hospitalizations	Government, health centers, physicians

It is important to note that these preventive actions require initial investment but offer a high social and economic return in the medium term, a major issue highlighted in the report available at this address on Ameli.fr Health Insurance.

Optimizing care pathways: a key project to control costs

The reorganization of care pathways is also an integral part of the 60 proposals presented for 2026. The current system shows some rigidity, leading to unnecessary or poorly coordinated referrals, which generate additional costs for Social Security.

The approaches adopted to improve this aspect mainly focus on:

• 🔄 Strengthening the role of the primary care physician as the central figure in management, ensuring consistent follow-up.
• 📋 Simplifying administrative procedures to limit formalities and promote direct access to care without bureaucratic overload.
• 🧰 Improving coordination between specialists and care structures.
• 🚑 Developing home care and telemedicine to reduce unnecessary hospitalizations.
• 💳 More rigorous management of third-party payment to avoid abuses and ensure equitable access to care.

A determined effort is underway to ensure these measures are accompanied by changes in professional practices while involving mutual societies that play a complementary role. The report emphasizes that resource optimization depends on better alignment between medical prescriptions and actual needs, thus avoiding unnecessary expenses.

Care Pathway Improvement 🚧	Expected Benefit 🎯	Economic Impact 💶
Enhanced role of primary care physician	Better care coordination	8% reduction in total expenses
Expanded telemedicine	Facilitated access and emergency decongestion	€500 million in savings
Strict management of third-party payment	Fraud reduction and fairness	€300 million in savings

This initiative is closely monitored by authorities due to its significant potential in healthcare savings, as it simultaneously promotes improved patient health and expenditure control.

Measures to regulate sick leave and limit abuse

The dynamics of sick leave is a sensitive issue prominently pointed out in the report. Since 2019, their number has experienced abnormal growth, significantly impacting healthcare expenditure management.

According to Thomas Fatôme, the increase rate differs from traditional factors like demographics or economic conditions, as 40% of this increase remains unexplained. This highlights the need to establish stricter rules without penalizing legitimate patients.

The key proposals to manage this aspect include:

• 📝 Obliging explicit mention of the reason for the sick leave on certificates, for greater transparency.
• ⏳ Regulating the duration of leave, aligned with scientific standards and modern medical practices.
• 🎯 Introducing a bonus-malus system for companies that promotes absenteeism prevention.
• 🔍 Strengthening controls and audits on sick leave prescriptions.

This approach aims to balance maintaining proper coverage by Social Security and combating financial abuses that weaken the system. A measured approach is essential to avoid hindering access to care while encouraging actor responsibility.

Measure on Sick Leave ⏱️	Targeted Goal 🎯	Estimated Economic Effect 💰
Mandatory reasons for leave	Transparency and abuse reduction	€400 million in savings
Company bonus-malus	Encourage prevention	€600 million in savings
Increased controls	Reliability of prescriptions	€500 million in savings

Rationalizing reimbursement of health services and products

Another major aspect of the proposals concerns managing reimbursements, especially for those currently covered entirely at 100% by Social Security. The report recommends adjusting this coverage based on the demonstrated effectiveness of procedures or treatments, particularly addressing unnecessary or disproportionate expenses.

The key measure is limiting full reimbursement to health products with scientifically proven efficacy. This applies to:

• 💊 Certain medicines whose therapeutic effectiveness is unproven or deemed insufficient.
• 🛏️ Interventions or treatments currently reimbursed at 100% even after remission, such as some cancers.
• 🌿 Additional services like thermal cures, which are debated regarding their actual contribution to public health.

This realignment of reimbursements aims to generate substantial savings by better compensating “just the right price” care, while strengthening mutual societies’ capacity to take over supplementary coverage.

Concerned Service 💡	Proposed Modification 🔄	Expected Savings 💸
Remission of cancer	Ending 100% coverage	€800 million
Medications with limited efficacy	Limiting reimbursement	€1.1 billion
Thermal cures	Considering maintaining 100%	€300 million

It is essential to ensure a gradual transition to preserve user confidence and social balance.

Social dialogue and taxation: levers for balancing stability and equity

The challenge of financial recovery also involves collective decisions on funding sources. Thomas Fatôme stated that Cnam does not propose measures to fill the current 16 billion euro deficit but emphasizes the need for a collective debate involving the government, Parliament, and social partners.

The scenarios considered include:

• ⚖️ An eventual adjustment of social contributions, linked to the economic situation of insured individuals and the overall context.
• 💵 Modulation of taxes allocated to Social Security, especially through behavioral taxes aimed at funding health prevention.
• 🤝 The increased role of mutual societies as supplementary partners in social protection.

This social dialogue is a major challenge in building a more sustainable health system, while avoiding disruptions in coverage. The goal is twofold: stabilize revenues while continuing expenditure optimization efforts, a delicate balance to achieve in an uncertain economic climate.

Leverage 💡	Objective 🎯	Potential Result 💰
Adjustment of social contributions	Increase revenues	Variable depending on scenarios
Behavioral taxes	Fund prevention and education	Several hundred million euros
Partnerships with mutual societies	Enhance coverage	Multiplier effect on health economy

Parliamentary debates and reactions following the presentation of the 2026 measures

The report’s submission was followed by lively debate in the National Assembly, where several deputies expressed their positions on the proposed measures. Some, like Nicole Dubré-Chirat, pointed out the need to reevaluate expenses such as thermal cures, denouncing an “incredible expense, not necessarily justified.” Others, like Théo Bernhardt, defended the social and economic role of these services in rural areas, highlighting their importance for jobs and regional attractiveness.

Beyond specific issues, there is a broad consensus on the urgency of adopting strong yet fair measures. Deputy Jérôme Guedj called for active mobilization to support the government in upcoming budget arbitrations, saying “we cannot have this material and wait with folded arms for arbitrations in which we can only influence marginally.”

Some points of convergence are nonetheless emerging around themes such as health prevention or fighting absenteeism, which should form a common foundation in the development of future Social Security Finance Bill. A broader consultation is expected to prevent the risk of social balances breaking apart and to ensure uniform access to care across the territory.

Parliamentary Position 🏛️	Main Argument 📢	Impact on Legislative Debate ⚖️
Nicole Dubré-Chirat	Reducing thermal spending	Pressure for reevaluation and savings
Théo Bernhardt	Maintaining thermal medicine for rural jobs	Defense of local sectors
Jérôme Guedj	Mobilization for strong measures	Call for collective action

Parliament is therefore set to examine this report in a climate where expenditure management, social security protection, and public health improvement will be central to discussions—crucial for the future of the system.

Perspectives on savings and challenges to ensure the sustainability of the Health Insurance system

The objective set by the Health Insurance is clear: the proposed measures must enable savings of up to 3.9 billion euros by 2026, with a projected cumulative savings of 19.5 billion euros by 2030. These figures emphasize the importance of a coordinated and swift action to curb the widening structural deficit.

Among the major challenges is the need for effective integration of measures within a complex system where actors with varied interests coexist: healthcare professionals, mutual societies, users, and public authorities. Resource optimization depends on a delicate balance between rigor and maintaining quality care.

Here are the main identified levers for savings:

• 💼 Controlling sick leave through strict regulation.
• 💊 Targeted regulation of medicines and services reimbursements.
• 🏥 Improving care pathways to avoid unnecessary procedures.
• 🛡️ Strengthening the effectiveness of health prevention actions.
• 📊 Joint mobilization of public and private stakeholders, including mutual societies.

This action plan reflects a desire to initiate a virtuous circle of safeguarding the French health system, a major challenge for social cohesion and economic stability. To follow the detailed evolution of these measures, several specialized sources provide comprehensive monitoring at aidebtsassurance.com.

FAQ – Frequently Asked Questions about the 2026 healthcare expenditure optimization measures

• ❓ What are the main causes of the massive deficit of Health Insurance in 2025?
  The deficit is due to an accelerated increase in medication expenses, unexplained growth in sick leaves, and practices such as fee overruns.
• ❓ How can health prevention contribute to controlling costs?
  By reducing the occurrence of chronic and preventable diseases, prevention decreases hospitalizations and heavy treatments, thus generating sustainable savings.
• ❓ What are the risks associated with excessive reimbursement limitations?
  They could widen inequalities in access to care, especially for vulnerable populations, highlighting the importance of a cautious balance between savings and quality of care.
• ❓ Will mutual societies have a greater role in the future system?
  Yes, they are expected to become essential partners to complement Social Security and support insured individuals with suitable coverage.
• ❓ When are these measures expected to come into effect?
  Some measures aim for impact from 2026, with gradual deployment until 2030 to ensure a smooth transition.

Source: lcp.fr