In his report Expenses and Income 2027Health Insurance is formulating 40 proposals aimed at informing the public debate and contributing to the Social Security financing bill. This report is structured around three main priorities: making a preventive shift; improve patient care pathways; reimburse the right care at the right price. Among other things, he suggests extending My psychological support to elderly people taking benzodiazepines and recommends promoting deprescription.
In a still constrained budgetary context, the Expenses & Products report for 2027 maintains the course set in the exceptional report of the previous year. Faced with a deficit estimated at 13.8 billion euros for 2026, Health Insurance is formulating savings options for 2027, amounting to 3.9 billion euros. Faced with current and future challenges, the report proposes structural orientations to ensure the viability of the health system while improving the quality of care and equity of access for all insured persons.
To further deepen the projections for 2030 presented last year, Health Insurance has enriched and completed the analyzes based on new studies or foreign experiences: impact of polypathologies, partnership with the OECD to assess the return on investment of prevention programs, and finally an unprecedented overview of the health situation in overseas departments and regions.
Financial projections demonstrating the need for a preventive shift
The projected Health Insurance deficit is estimated at 13.8 billion euros in 2026, down by more than 2 billion compared to 2025, i.e. a return to the 2024 level. This improvement is due in particular to higher than expected revenues, but the outlook remains very worrying, because the pressure of aging and chronic diseases in particular continues to weigh heavily on the health system.
By 2035, according to Health Insurance estimates, nearly one in two people would be affected by a chronic illness, representing a total number of 27.7 to 30.4 million people. At the same time, nearly 1 in 5 adults today live with several simultaneous chronic illnesses.
These polypathology situations lead to significant additional costs (+8,863 euros on average in 2024 compared to a person without polypathology) and higher mortality. Depending on the scenarios observed, chronic pathologies could represent up to 70% of the total reimbursed expenditure in 2035 (compared to 65.1% in 2024).
If the current trend continues, health spending could reach 270 billion euros by 2030 (+€60 billion compared to 2024). By acting more on the relevance and effectiveness of spending, via “voluntaristic” regulation, this increase could be contained to 255 billion euros.
But only a massive investment in prevention, combined with stronger spending control, could contain health spending to the tune of 245 billion euros, while allowing policyholders to live longer in good health.
Health Insurance finally anchors all of the identified scenarios around a strong conviction: need to make health spending evolve at the same rate as the growth of national GDP, the only way to ensure the financial sustainability of our system.
Axis 1 – Prevention: the major ten-year cause
This year, Health Insurance wanted to establish an unprecedented partnership with the OECD, in order to objectify and evaluate in the long term the return on investment of prevention policies.
The analysis shows that a coherent strategy, combining complementary interventions throughout life and targeting different risk factors, generates significant health and economic gains. :
- promote a healthy and sustainable diet (Nutri Score);
- protect young people and act on respiratory diseases (Health Insurance supports the proposed law “For a tobacco-free generation” aimed at banning the sale of tobacco to a certain age group, screening for COPD and lung cancer).
- Screen and support from an early age (visual disorders, language disorders). Furthermore, faced with the increase in suicide attempts and self-mutilation among young people, Health Insurance wishes to rely on the positive results of the experiments implemented within the framework of article 51 to act on two key levers for this age group: reduce the time taken to access specialized care and offer appropriate care
Axis n°2 – Taking care of chronically ill people in the right place and at the right time
For people with chronic illnesses, proximity and coordination of care are essential. Health Insurance considers that community medicine is the basis of the care pathway for these patients.
– Put the patient back at the heart of their care. Improving care in the city also requires better consideration of the patient experience. Health Insurance has significant assets to accelerate this dynamic in France, in particular thanks to the collection of patient experience already engaged in experiments carried out with multi-professional healthcare centers (PEPS and IPEP).
– Coping with the aging of the population
While by 2035, people over 75 should represent 13.5% of the population, Health Insurance is identifying concrete measures to promote healthy aging:
– Deploy a vaccination campaign against pneumococci among the elderly:
– Extend my psychological support to elderly people under treatment with benzodiazepines, in order to better meet their psychological needs. Today, a quarter of people aged 65 and over have benefited from reimbursement for benzodiazepines during the year. The report also recommends promoting early diagnosis of neurodegenerative diseases in cities, to intervene before situations deteriorate.
–Develop temporary accommodation via regional health agencies, to liquefy. the care pathway for elderly people leaving SMR and encouraging their return home
Finally, the report sheds new light on hospital activity. Between 2017 and 2023, the volume of care per bed fell slightly during the Covid epidemic (decrease of -0.5%) but has not returned to its previous level. If large health establishments have held up better, those of a more limited size have experienced a more lasting decline, linked in particular to an older patient population and longer stays. The challenge is therefore to appropriately position the role of these establishments by better articulating their activities with professionals in the city, the medico-social sector and other hospital stakeholders to ensure a gradation of care and enable more efficient and coherent pathways.
Axis n°3 – Structuring actions to pay for the right care at the right price
To restore a sustainable spending dynamic for the community, strong actions must be taken now, with one requirement: financing the right care at the right price. Based on medico-economic analyses, the report highlights the need for structural transformations, both in health products and in the actions of certain health professions.
Regulating drug spending at the heart of the efficiency strategy
With the aging of the population, the increase in chronic diseases and the arrival of innovative treatments, drug expenses reimbursed by Health Insurance continue to increase sharply: particularly in oncology which represents a quarter of drug expenses and is the main driver of growth. Thus, net spending on anticancer drugs reached 7.1 billion euros in 2024, an increase of 10.2% per year over five years.
In order to optimize the prescription of these therapeutic innovations, Health Insurance offers a more targeted approach:
▪ favor the most efficient treatments;
▪ reduce the intensity or duration of certain protocols without loss of opportunity for the patient;
▪ better adapt care to elderly people with cancer.
More generally, the older patients get, the more treatments are combined, sometimes with serious effects on their quality of life. This is why Health Insurance recommends promoting deprescribing, in town and in hospitals, by providing healthcare professionals with dedicated tools, or by setting up a dedicated consultation to take stock of medications, at the time of entry into an EHPAD.
Continue efforts to prevent and control work stoppages
The particularly marked dynamism of daily compensation for work accidents and occupational illnesses (+30% in 5 years) is mainly explained by the increase in the duration of these stoppages. The report makes several proposals to strengthen the prevention and monitoring of these long stoppages.
Fight against fraud: a fruitful mobilization that must continue
In 2025, the fight against Health Insurance fraud reached a new milestone, with nearly 723 million euros in financial losses detected and stopped, an unprecedented result demonstrating the effectiveness of control and detection systems which must continue. The report suggests going further in securing the current billing and prescription system, by continuing to dematerialize flows, by regulating billing deadlines or even by making third-party payers conditional on the presentation of the Vitale card.
Axis n°4 – The DROMs: major public health issues, which call for strong mobilization adapted to local contexts
Health Insurance wanted, in this edition for 2027, to have a dedicated focus on the health situation in the overseas departments and regions.
Although the health realities are contrasting, these territories present less favorable health indicators than in mainland France and are faced with specific and obvious vulnerabilities (increased climatic and epidemic risks, access to care sometimes more difficult linked to their insularity and remoteness, poverty rate 2 to 4 times higher than in mainland, infectious diseases more present, etc.).
In order to respond to these major challenges and to guarantee equity in access to care, Health Insurance has made more than ten strong proposals to improve prevention and the organization of care:
- Strict alignment of the sugar levels present in products marketed in the Droms with those distributed in mainland France
- Launch of a major Diabetes Plan in overseas departments and regions, like the one deployed in Reunion
- Dedicated strengthening of the My Psy support system and adaptation to local specificities
- Combined and innovative actions in sexual health, in conjunction with field workers
- Improved participation in early screening (cancers in particular)
- Prevention for children: perinatal, overweight and obesity, addictions.
The previous Expenses and Products report had set a clear and ambitious trajectory: ensuring that expenditure and revenues evolved in line with national wealth by 2030, which implies making 3.9 billion euros in savings per year. The report therefore documents this same objective of €3.9 billion
Presentation of the annual report “Expenses and Products for 2027”: 40 proposals – keys to Health Insurance for the future of our health system
