L’Assurance maladie proposes 60 measures to optimize healthcare spending and aims for 3.9 billion euros in savings by 2026

Faced with a concerning financial emergency, the Healthcare Insurance has unveiled an ambitious set of 60 measures aimed at controlling and optimizing healthcare expenditures in France. In a context where the deficit is forecasted 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 fair and efficient healthcare system, while saving €3.9 billion by 2026. These initiatives range from promoting enhanced health prevention to rigorous management of care pathways, including rationalizing reimbursements and implementing stricter controls on sick leave.

The announcement comes at a key period when parliamentary debates on the Social Security financing bill are expected to be particularly challenging. This determined action by Healthcare Insurance highlights complex but essential levers to ensure the financial sustainability of the system while maintaining the quality of medical care. The report “Improving the quality of the healthcare system and controlling expenses,” published in early July 2025, outlines a multidimensional strategy with proposals covering prevention, care pathways, and the pricing of health services and products, including medicines and sick leave coverage.

The measures are already subject to intense debate among parliamentarians and sector stakeholders, especially on thorny issues such as limiting fee overruns and revising reimbursements to 100% for certain services. Broad consensus remains to be built to turn these proposals into concrete actions, while taking into account the social and economic importance of Social Security within the French system. The upcoming legislative steps will determine the ability to balance resource optimization with the maintenance of equitable health coverage, a key challenge for public health and mutual insurance partners involved in this system.

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

The “charges and revenues” 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 worrying levels. Without corrective measures, the deficit could soar to 25 billion euros by 2030, indicating an unsustainable trajectory for Social Security and mutual insurers.

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

The domains where cost growth is most pronounced include:

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

To better visualize these trends, the following table summarizes the main expense items impacted:

Expense Item 🔍	Annual Growth Rate (%) 📈	Share of Total Expenses (%) 💰
Medicines	4.2	22
Sick leave	3.5	14
Fee overruns	2.8	7
Thermal cures	1.0	1

This financial diagnosis, based on precise data, underpins the 60 proposals aimed at stabilizing Social Security, in close connection with strategies to improve public health and optimize resources.

Health prevention at the core of proposals to curb rising costs

Health prevention is a key lever in the 2026 report. It emerges as the main strategy to improve the overall health of the population while limiting expenditure growth. Marguerite Cazeneuve, Deputy Director of Cnam, recalls 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, we find:

• 🩺 The widespread screening for high blood pressure, a major risk factor for cardiovascular diseases.
• 🍎 The promotion of enhanced health education campaigns on lifestyle, including diet and physical activity.
• 🚭 The establishment 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 encouragement for mutual insurers and healthcare providers to incorporate these preventive practices into their offerings. The system of third-party payment is also analyzed to encourage the reduction of financial barriers to access preventive care, thus facilitating better coverage at early signs.

An concrete example is the recent screening campaign for hypertension in several regions, which enabled early detection of often asymptomatic cases, thereby reducing expected heavy hospitalizations. This pragmatic approach underscores the importance of preventive measures in an effective health economy strategy.

Preventive Measure 🚑	Expected Impact 📈	Involved Partners 🤝
Hypertension screening	Reduce cardiovascular complications by 15%	Cnam, general practitioners, mutual insurers
Anti-smoking/alcohol campaigns	Decrease consumption by 10 to 20% depending on regions	Government, local authorities, associations
Enhanced vaccination	Reduce winter hospitalizations	Government, health centers, doctors

It should be noted that these preventive actions require initial investment but offer high social and economic returns in the medium term, a major issue highlighted in the report available at this address on Ameli.fr Healthcare Insurance.

Optimization of care pathways: a key area to control expenses

The reorganization of care pathways is also part of the 60 proposals presented for 2026. The current system shows rigidity that results in unnecessary or poorly coordinated referrals, leading to additional costs for Social Security.

The proposed avenues for improvement mainly focus on:

• 🔄 Strengthening the role of the primary care physician as the pivot of care, ensuring coherent follow-up.
• 📋 Simplifying administrative procedures to limit démarches and facilitate direct access to care without bureaucratic overload.
• 🧰 Improving coordination between specialists and healthcare structures.
• 🚑 Developing home care and telemedicine to reduce unnecessary hospitalizations.
• 💳 More rigorous management of third-party payment to prevent abuse and promote equitable access to care.

Decisive action is being taken to ensure these measures are accompanied by changes in professional practices while involving mutual insurers, who play a complementary role. The report highlights that resource optimization depends on better alignment between medical prescriptions and actual needs, thus avoiding unnecessary expenses.

Improvement of care 🚧	Expected benefit 🎯	Economic impact 💶
Enhanced role of the primary care physician	Better care coordination	8% reduction in overall expenses
Extended telemedicine	Easier access and reduced emergency department overload	€500 million in savings
Stricter management of third-party payment	Reduction of fraud and inequalities	€300 million in savings

This initiative is closely monitored by authorities given its significant potential for health economy savings, as it promotes both improved patient health and expenditure control.

Measures to regulate sick leave and limit abuse

The dynamics of sick leave are a sensitive and pointed subject in the report. Since 2019, their number has been growing at an abnormal rate, significantly impacting healthcare expenditure management.

According to Thomas Fatôme, the increase exceeds typical factors such as demographic changes or economic conditions, as 40% of this increase remains unexplained. Consequently, there is a need to establish stricter rules without penalizing legitimate patients.

The key proposals to control this aspect include:

• 📝 Obligation to explicitly mention the reason for sick leave on certificates, for greater transparency.
• ⏳ Setting boundaries for leave durations, aligned with scientific references and modern medical practices.
• 🎯 Introducing a bonus-malus system for companies to promote absenteeism prevention.
• 🔍 Strengthening controls and audits of sick leave prescriptions.

This approach aims to balance maintaining good coverage by Social Security with fighting financial abuses that undermine the system. A measured approach is essential to ensure access to care while encouraging responsibility among stakeholders.

Measure on sick leave ⏱️	Targeted Objective 🎯	Estimated Economic Effect 💰
Mandatory reasons for leave	Transparency and abuse reduction	€400 million in savings
Employer bonus-malus system	Encourage prevention	€600 million in savings
Strengthened controls	Prescription reliability	€500 million in savings

Rationalizing reimbursement of health services and products

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

The flagship measure is to limit full coverage to health products with scientifically proven efficiency. This applies to:

• 💊 Certain medicines whose therapeutic efficacy 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 significant savings by compensating for care “just at the right price,” while strengthening the mutual insurer’s capacity to take over supplementary coverage.

Service Concerned 💡	Proposed Change 🔄	Expected Savings 💸
Remission of cancer	End of 100% coverage	€800 million
Less effective medicines	Limit reimbursement	€1.1 billion
Thermal cures	Reflect on maintaining 100%	€300 million

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

Social dialogue and taxation: levers to combine balance and equity

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

The envisaged scenarios include:

• ⚖️ Possible adjustment of social contributions, linked to the economic situation of insured individuals and the overall context.
• 💵 Modulation of taxation dedicated to Social Security, notably through behavioral taxes aimed at funding health prevention.
• 🤝 An increased role for mutual insurers as complementary partners in social protection.

This social dialogue is a major challenge for building a more sustainable healthcare system, while avoiding breaks in coverage. The goal is twofold: to stabilize revenue while continuing resource optimization efforts, a delicate balance to achieve in an uncertain economic climate.

Leverage 💡	Objective 🎯	Potential Result 💰
Adjustment of social contributions	Increase revenue	Variable depending on scenarios
Behavioral taxes	Fund prevention and education	Several hundred million euros
Partnership with mutual insurers	Improve coverage	Multiplied effect on health savings

Parliamentary debates and reactions following the 2026 measures presentation

The submission of the report was followed by a lively debate in the National Assembly, where several deputies expressed their positions on the proposed measures. Some, like Nicole Dubré-Chirat, pointed to the need to reassess expenses such as thermal cures, condemning “an incredible expense, not necessarily justified.” Others, like Théo Bernhardt, defended the social and economic role of these treatments in rural areas, emphasizing their importance for employment and territorial attractiveness.

Beyond specificities, the general consensus seems to emphasize the urgency of adopting strong but fair measures. Deputy Jérôme Guedj called for active mobilization to support the government in upcoming budget decisions, stating that “we cannot have this material and wait passively for arbitrations over which we can only have a marginal influence.”

Some convergence points are nonetheless emerging on themes such as health prevention or absenteeism reduction, which should form a common foundation in the development of the future PLFSS. Broader consultation is expected to prevent the risk of social balance disruption and to ensure uniform access to care across the territory.

Parliamentary Position 🏛️	Main Argument 📢	Impact on Legislation ⚖️
Nicole Dubré-Chirat	Reducing thermal expenditure	Pressure for reassessment and savings
Théo Bernhardt	Maintaining thermal treatments for rural employment	Defense of local sectors
Jérôme Guedj	Mobilization for strong measures	Call for collective action

Thus, Parliament is about to examine this report in a climate where expenditure management, the protection of Social Security, and the improvement of public health will be central to debates, critical for the system’s future.

Perspectives of savings and challenges to ensure the sustainability of the Healthcare Insurance system

The clear goal set by Healthcare Insurance is that the proposed measures should allow savings of up to €3.9 billion by 2026, with a cumulative projection of €19.5 billion in savings by 2030. These figures highlight the importance of coordinated and swift action to curb the growth of the structural deficit.

Among the major challenges is the efficient integration of measures into a complex system where stakeholders with varying interests coexist: healthcare professionals, mutual insurers, users, and public authorities. Resource optimization depends on a delicate balance between rigor and maintaining quality of care.

Here are the main identified levers for savings:

• 💼 Mastering sick leave through strict regulation.
• 💊 Targeted regulation of medicine and service reimbursements.
• 🏥 Improving care pathways to prevent unnecessary procedures.
• 🛡️ Strengthening the effectiveness of health prevention actions.
• 📊 Joint mobilization of public and private actors, including mutual insurers.

This action plan reflects a desire to initiate a virtuous circle of safeguarding the French healthcare system, a major challenge for social cohesion and the country’s 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 Proposed 2026 Healthcare Expense Optimization Measures

• ❓ What are the main causes of the significant deficit of Healthcare Insurance in 2025?
  The deficit is due to accelerated growth in medication expenses, unexplained increases in sick leave, and practices such as fee overruns.
• ❓ How can health prevention contribute to cost control?
  By reducing the occurrence of chronic and avoidable diseases, prevention decreases hospitalizations and intensive treatments, thereby generating sustainable savings.
• ❓ What are the risks associated with excessive reimbursement limitations?
  It could increase healthcare access inequalities, especially for vulnerable populations, highlighting the importance of a cautious balance between savings and quality of care.
• ❓ Will mutual insurers 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 adequate coverage.
• ❓ When are these measures expected to come into effect?
  Some measures aim to produce an impact as early as 2026, with gradual deployment until 2030 to ensure a smooth transition.

Source: lcp.fr