LFSS: the key measures of the French Social Security Financing Act for the year 2023

The Social Security Financing Act for the year 2023 (LFSS 2023) was finally passed on December 2, 2022. For you, Alcimed looks back at the major changes that will be in place as of January 2023.

What are the objectives of the LFSS?

The Social Security Financing Law allows the French government and Parliament to set the amount of money allocated to each branch of social security (health, work-related accidents and illnesses, old age, family and autonomy) each year – with the aim of ensuring the sustainability of public spending, but also to determine the main lines of France’s social protection policy.

The Social Security Financing Act improves the financial health of French Social Security while supporting the financial effort in favor of health

If we compare Social Security expenditures to revenues, we find a deficit of €6.8 billion. Paradoxically, this marks a clear improvement in the accounts.

For 2023, French Social Security expenditures are estimated at €602 billion. The payment of benefits, such as retirement pensions or health care reimbursements, represents the bulk of this expenditure. These benefits are paid by the five branches of social security, each of which covers a major risk in life.

These expenditures are financed mainly by the social security contributions paid by all employees and employers and by the allocated taxes paid by each taxpayer, including retirees and job seekers (the best known is the generalized social contribution). For 2023, Social Security revenues are estimated at about €595 billion.

The health crisis had caused a historic deficit of more than €39 billion in 2020. The French Social Security budget was hit by both a decrease in revenue due to the mobilization of short-time working, and an increase in expenditure, particularly in hospitals. The increase in revenue and the decrease in expenditure committed since 2021 now make it possible to control this imbalance.

As this deficit is financed by public debt, the return to balance is therefore positive news for the sustainability of all public spending.

The news is all the more positive in that this recovery of the social accounts has not prevented the French government from making a constant effort in favor of health care spending.

The national health insurance expenditure target (ONDAM) defines the resources available for each of the components of the health care system (health care institutions, outpatient medicine, etc.) and makes it possible to control their use during the year.

In the context of the health crisis and the commitment to reforms to transform the health system, in particular the major salary increases decided at the Ségur health summit, the ONDAM has increased significantly, in contrast to the strong constraint that had weighed on it since the early 2000s.

The 2023 LFSS continues this trend with an increase in spending not devoted to managing the health crisis: this will primarily benefit establishments and services for the elderly and the disabled.

What are the 5 measures planned in the LFSS 2023?

In parallel to this financial commitment of the French government to health, five cross-cutting priorities have been set for the year 2023.

1. Reinforce the preventive shift

Prevention is a way to fight against health inequalities, to better control health expenses and to improve life expectancy in good health. Three main actions are included in the LFSS:

• Prevention appointments for the entire adult population have been created – whereas they were previously reserved for children. Each individual will benefit from a consultation at the age of 20-25, 40-45 and 60-65 with a specific theme (chronic diseases, loss of autonomy, etc.).
• To improve sexual health, over-the-counter screening (free for young people) has been extended and emergency contraception is now free.
• Pharmacists, nurses and midwives will be able to prescribe vaccines to increase the population’s vaccination coverage and simplify the vaccination process.

2. Improving access to health care

Enable access to care throughout the country

Access to healthcare professionals is still insufficient, with nearly 4 million French people living in a medical desert. Three measures should be noted.

• The perpetuation of the summer measures to facilitate the recruitment of liberal regulating doctors within the service of access to care (SAS).
• The renovation of the installation of liberal doctors, in particular general practitioners:
  • a fourth year of study has been added to the general medicine diploma in order to bring it into line with other specialties and facilitate the installation of doctors.
  • the measures to assist the installation and maintenance of private practitioners, currently offered by the Health Insurance, the State and certain local authorities, will be harmonized to make them more attractive and simpler.
• Strengthening the regulation of temporary medical staff to protect the financial resources of hospitals.

Guaranteeing access to innovative therapies for all

The challenge is to promote access to innovation and to guarantee the financial sustainability of social finances for these treatments, which differ greatly from the traditional reimbursement model (very high cost but lasting benefit).

Payments to the pharmaceutical industry will now be spread out over time and may be modulated according to the results observed.
The LFSS 2023 thus shares the risks between the pharmaceutical company and the health insurance company, while health care institutions will be reimbursed immediately.

Learn more about the challenges of optimizing patient care pathways >

3. Building a society for ageing well at home

To meet the challenge of aging and improve care, the LFSS proposes several types of action.
In particular, up to two additional hours per week devoted to social ties are provided for in the plans for assistance with loss of autonomy. The objective here is to better prevent the loss of autonomy, but also to improve the attractiveness of the homecare profession by allowing professionals to devote themselves to their support role independently of the technical gestures to be performed.
In addition, EHPADs will benefit from the recruitment of 50,000 nurses and care assistants.

4. Improving the care of young children

In 2023, the LFSS focuses on financial support for families – particularly for single-parent families, which represent the majority of poor families.

• The family support allowance is increased.
• The childcare supplement is modified to better correspond to the reality of families (alternating custody, diversity of childcare arrangements, etc.)

5. The fight against tax fraud

The French government is strengthening control mechanisms to better prevent and punish fraud, particularly among healthcare providers and service providers.

Thus, the 2023 LFSS provides for an increase in spending on health beyond the management of the health crisis and includes measures concerning the structuring issues of the health and medico-social sectors. These priorities defined for the financing of the French Social Security echo the expertise developed by Alcimed around public health and medico-social policies.

• For example, Alcimed has accompanied the CNAV in the creation of VIVA Lab, a partnership and territorial support system for innovative projects for good ageing and prevention of loss of autonomy,
• Alcimed accompanies the ARS in the structuring of their Emergency Care Access Service, their coordinated devices or the managers of establishments in the deployment of new innovative projects for the care of elderly or disabled people.

From the Social Security financing model to the operational implementation, from the apprehension and the proposal of new public health policies to their territorial declination and their evaluation, Alcimed is there to accompany you, do not hesitate to contact us!

A propos de l’auteur, 

Louise, Consultant in the Alcimed’s Innovation and Public Policies team in France