Macro-économie / Taux
Macro-économie / Taux
Finances publiques : les dépenses de santé progressent plus vite qu’escompté / Les soins de ville mis en cause
Dans un avis, le Comité d’alerte sur l’évolution des dépenses d’assurance maladie a fait valoir qu’il y avait un risque qu’elles s’établissent plus d’un milliard d’euros au-dessus de ce qui est prévu dans la loi de financement de la sécurité sociale pour 2024. Le chiffre pourrait être ramené à un peu plus de 500 millions d’euros en prenant notamment en compte les réserves mobilisables.
ANTOINE BOUREAU / Hans Lucas / Hans Lucas via AFP
Un nouveau vent contraire pour les finances publiques françaises. Un avis du Comité d’alerte sur l’évolution des dépenses d’assurance maladie évoque un risque que ces dernières s’affichent à un étiage supérieur à ce qui est prévu pour 2024 (objectif national des dépenses d’assurance maladie – Ondam). Cette instance, entre autres composée de Jean-Luc Tavernier, directeur général de l’Insee, chargée d’alerter le Parlement, le gouvernement et les caisses nationales d’assurance maladie en cas d’évolution des dépenses d’assurance maladie incompatible avec le respect de l’objectif national voté par le Parlement, est interpellée par la dynamique des dépenses ayant trait aux soins de ville au cours du premier semestre 2024.
Durant cette période, ces dépenses brutes effectives ont augmenté de 5,7 % par rapport à la même période de l’année 2023 pour le régime général de sécurité sociale. “Cette augmentation dépasse de 1,5 point la hausse de 4,2 % des dépenses brutes du sous-objectif prise en compte dans l’Ondam pour 2024 adopté dans le cadre de la loi de financement de la sécurité sociale (LFSS) pour 2024”, fait remarquer le Comité.
Dans le détail, cet écart concerne la plupart des postes de soins de ville : actes de biologie médicale, transports de patients, honoraires des médecins spécialistes, honoraires des masseurs-kinésithérapeutes, indemnités journalières, dispositifs médicaux, médicaments. “Il traduit la dynamique du volume des actes, des biens et des prestations pris en charge par l’assurance maladie”, explique l’avis.
Si l’on extrapole cette tendance à l’ensemble de 2024 en tenant compte des mesures telles que le doublement des franchises et des participations forfaitaires (en vigueur depuis le printemps), le surplus de dépenses par rapport à l’objectif pourrait atteindre un peu plus d’un milliard d’euros sur l’année.
Alors que le montant prévisionnel de l’Ondam 2024 comprend une réserve de 765 millions d’euros pour faire face notamment à des dépassements, le Comité juge qu’un peu moins de la moitié (350 millions d’euros) serait mobilisable (est pointée la part difficilement compressible destinée aux établissements de santé).
De sorte que l’Ondam prévu par la LFSS pour 2024 "pourrait être dépassé de plus de 500 millions d’euros, sous l’hypothèse d’une progression en moyenne sur l’année identique à celle des six premiers mois et avant mise en œuvre de mesures supplémentaires de maîtrise des dépenses", juge le Comité. Bien qu’inférieur au seuil d’alerte fixé à 0,5 % du montant prévisionnel des dépenses de l’Ondam, soit 1,3 milliard d’euros, il porte sur un "montant significatif de dépenses".
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