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Tobacco, the morning after pill … The main measures of the Social Security draft budget

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Falling deficit, free morning after pill, rising tobacco prices… Here are the main measures of the Social Security financing bill for 2023, on the menu of the Assembly from Thursday.

deficit side

Since the abyssal record of 2020 (nearly 39 billion), the losses have continued to reduce: less than 25 billion in 2021, 17.8 billion this year and, therefore, 6.8 billion expected in 2023. A figure however subject to caution, because largely due to the melting of the Covid-19 bill: the provision for tests and vaccines would fall from more than 11 billion in 2022 to only one billion next year, an amount which “risks prove to be very insufficient” to cover the expected expenses, according to the High Council of Public Finances.

About the savings

As in previous years, the budget does not provide for savings on the hospital, but savings of 1.1 billion euros on the reimbursement of medicines, 250 million on medical analysis laboratories, 150 million on medical imaging, and finally 150 million euros in supplementary health insurance are planned. There should be no reduction in the number of laboratory establishments, pointed out the rapporteur Stéphanie Rist (Renaissance).

On the teleconsultation side

Work stoppages prescribed by teleconsultation by a professional other than the treating doctor or a doctor seen in the last twelve months will no longer be reimbursed.

Tobacco prices on the rise

The price of tobacco “will increase like inflation”, declared Prime Minister Elisabeth Borne. The average price of the package, today 10.15 euros, must thus increase to 11 euros in 2024. The government did not specify the expected gain, but underlines that the tax on tobacco brings in between 13 and 14 billion per year, against a cost of 20 to 26 billion euros for health insurance.

Prevention and sexual health ahead

To fight against social inequalities in health, prevention consultations will be offered at key ages in life (20-25, 40-45 and 60-65). Emergency contraception will be free for all women, regardless of age. “Even today, one in three pregnancies is unplanned”, and in these cases, six out of ten end in a voluntary termination of pregnancy, recalls the Ministry of Health.

The text also plans to make it possible to screen for certain sexually transmitted infections (including chlamydia and gonococci) without a prescription for everyone and free of charge for those under 26.

Opening of vaccination

Pharmacists and nurses will be given the capacity to prescribe vaccines. Midwives will be able to vaccinate more people, their field being until now limited to women, children and those close to pregnant women.

Extended medical studies

The internship for general practitioners will be extended by one year, with internships outside the hospital and “as a priority” in medical deserts, to better train them in liberal practice and support their installation. A consultation will be organized to find the “good conditions” for this additional year, specifies the Ministry of Health.

And the interim?

Young caregivers will no longer be able to work on a temporary basis as soon as they leave school, but must first practice “in another framework”, salaried or liberal, “for a minimum period” which will be fixed by decree. The government stresses that this practice “destabilizes the teams” and costs hospitals more and more: 500 million euros in 2013, more than 1.4 billion in 2018.

What about nursing homes?

Some 3,000 nurses and nursing assistants will reinforce the workforce of nursing homes, the first stage of a plan which aims to recruit 50,000 additional people by 2027. There will be added 4,000 additional places in home help services.

The Orpéa post-scandal requirements on the transparency and financial regulation of medico-social establishments and services have been completed.

Help for children

The financial assistance paid to families who have their child looked after by a childminder will be reassessed, so that their remaining dependents are the same as if the child benefited from a place in a crèche.

Single-parent families will now receive financial assistance for childcare until they enter college, and no longer until the start of CP. And the minimum alimony paid to them by the CAF in the event of default by the other parent will be increased by 50%, from 123 to 185 euros per month.

The issue of spa treatments

In committee last week, the deputies planned to condition the reimbursement of spa treatments to the evaluation of their “medical service rendered” by the High Authority for Health (HAS). The measure will have to be voted on again in the hemicycle.

Other amendments were voted in committee without the approval of the rapporteur, and are in the hot seat: in particular on equal pay for women and men and for the abolition of old-age contributions for doctors in combined employment and retirement. An LR amendment providing that teleconsultations be carried out by the patient from a nursing home or a pharmacy will also be highly debated.

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