Health reimbursements linked to income supported by French state auditor

Income-based healthcare reimbursements is one of the ideas put forward by the state auditor as a way to rein in France’s high social security spending.

The Cour des comptes has invited the government to consider the proposal under the heading of “making insured people more responsible”.

Its latest report is intended to inform preparations for the 2026 budget, which the government is already planning in an effort to avoid the delays experienced this year, when the annual budget law was not finalised until mid-February.

Prime Minister François Bayrou also addressed the issue in a speech titled 'The time for truth', in which he stated that France must take decisive action to reduce its public debt and budget deficit. 

Glasses, dentistry, hearing aids: Major changes to reimbursement rules proposed

The Cour des comptes’ recommendations include reducing the portion of certain “uncertain” medical benefits that are refunded -such as spa treatments - and halting reimbursement of spa accommodation or transport costs unless the treatment is for a recognised long-term condition.

The report also called for a reduction in prescriptions of medications it says are often given unnecessarily, including Vitamin D supplements and drugs for acid reflux. 

It suggested France “rethink what should be reimbursed, dependent on people’s incomes, as Germany does”. In Germany, patients pay a portion of healthcare costs based on their income—zero for the least well-off—before state reimbursement applies.

Mr Bayrou stressed that France currently spends almost as much of its national budget on interest payments as it does on education, with public debt amounting to €50,000 per person. 

While his speech stopped short of announcing specific measures, it is widely viewed as a first step in preparing the public for difficult decisions ahead.

He outlined the various challenges that have destabilised the country in recent years—including the gilets jaunes protests, the Covid pandemic, the war in Ukraine, and increasingly difficult relations with the United States. 

He also flagged future pressures such as an ageing population and increased defence spending, needed to ensure the EU’s autonomy.

Among the structural problems he identified are insufficient numbers of young and older people in the workforce, a lack of domestic production of basic goods, the need to re-industrialise, a trade imbalance, and high public spending that he said often yields disappointing results.

Bayrou ruled out raising taxes or taking on more debt as viable solutions. Instead, he called for savings and more efficient government practices, warning that without them, France risks a credit rating downgrade and higher borrowing costs. 

“We must guarantee the survival of our social model,” he said, adding that people expect a reliable social safety net.

He promised to present “concrete” solutions to the issue of medical deserts—areas lacking healthcare professionals—by May. 

He has asked every ministry to review its operations, assess whether its work is still relevant, and ensure that there is no duplication of efforts.

The government is also evaluating around 467 niches fiscales—tax breaks and incentives—to identify and eliminate those that are ineffective.