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As the 2025 budget elections approach, Health Insurance is concerned about an “unsustainable” increase in sick leave spending.

“I'm sick…” The expression has now become part of the everyday language of corporate life. But has the reflex to “call in sick” become too common and too permissible? Slowly but surely, the car seems to be catching up over the years and accumulated deficits. So much so that Health Insurance has warned of an “unsustainable” rise in sick leave costs.

According to the director of the National Health Insurance Fund (Cnam), Thomas Fatôme, compensation expenses for people on sick leave increased sharply again by 8% in the first half of 2024, which could generate expenses of 17 billion euros a debt of 11.4 billion euros per year. If demographic and economic factors have helped to justify much of this growth for several years, the numbers show that they are no longer the only elements to consider.

Demographics and inflation

Between 2019 and 2023, 19% of the per diem increase was related to demographic factors (change in the working population, aging population). In the period 2010-2019, this figure was 42%. Economically, inflation has led to an increase in the minimum wage and wage increases that have driven the mechanical increase in per diems in recent years. As indicated Les Echosthis effect is responsible for 39% of the increase between 2019 and 2023, twice as much as between 2010 and 2019.

Therefore, these two factors account for 58% of the recent growth that can be explained by these criteria alone. For Cnam, other factors, to be determined, clearly come into play “It's an important, difficult, complicated debate,” admitted Thomas Fatôme. In a year where spending rises by a billion euros, such as in 2024, “that's 400 million euros” in additional spending not explained by demographics and the economy.

Call rate and duration

Once economic and demographic factors are invoked, 42% of the increase in spending remains to be justified. And according to Health Insurance, this share is explained by an increase in the appeal rate and the duration of these stops. “Employees are on average stopping for longer and generally more of them are affected by a work stoppage,” Damien Vergé, director of strategy, studies and statistics at Cnam, explained simply during a press conference. As for the precise reasons for the increase in these two factors, “we cannot separate what is a normal evolution of the health status of the population from what is abusive behavior” or fraud, stated Thomas Fatôme.

Fraud and complacency

A fraud difficult to quantify, but well taken into account by Cnam which has carried out numerous measures since 2023. Especially with the increase in the number of contacts (and not more checks) with doctors “whose prescription levels are high”. Some doctors are suspected of complacency towards policyholders who will be increasingly monitored. “We have summoned 270,000 insured in 2023. In about 30% of cases, the stoppage of work is not justified,” revealed Thomas Fatôme on franceinfo.

Cnam will also organize visits to a thousand companies with more than 200 employees with high absenteeism to check that they do not create the “conditions” for these sick leaves.

Union cry

This position taken by Health Insurance obviously did not please everyone. The Unsa union emphasized that it is necessary to “stop the stigmatization of the sick” and to address the root causes, which are more severe and numerous pathologies, longer careers and increasing psychosocial risks.

On the side of the cleaning doctors, the unions regret that they were singled out. Jérôme Marty, President of the French Union for Free Medicine (UFML), had already expressed himself on this question in our columns asking, “What interest does a doctor have in abusing work stoppages?” According to the Toulouse doctor, “excessive guilt tripping is of no use. The profession is already sticking its tongue out, how can the public authorities make us look like patrons?”

According to CFDT General Secretary Marylise Léon, it is not the doctors who abuse, “it is the work that is sick”.

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