Improving the quality of the healthcare system and controlling expenses — Proposals from Health Insurance for 2027

📜🔗LINK to the source

1. ANALYTICAL SUMMARY

An unprecedented deficit that forces a change of approach

The deficit of the health branch reaches -€15.9 billion by the end of 2025, after -€13.8 billion in 2024 and -€11.1 billion in 2023 (p. 9). It would decrease to -€13.8 billion in 2026, but only thanks to new revenues, not to a control of expenses (p. 10). In the face of this unprecedented level outside of a crisis, the CNAM has conducted a projection of its expenses towards 2030: in a trend scenario, they would reach €270 billion (+€60 billion vs 2024); a proactive regulation would bring them down to €255 billion; only the addition of a true preventive shift would allow them to be contained at €245 billion while gaining years of healthy life. The report structures its response around three priorities: prevention, care pathways, fair care at a fair price.

Equipped proposals and new angles

The report formulates 42 proposals (of which 40 highlighted by management) for €3.9 billion in savings by 2027, in the 2030 trajectory (p. 251). It innovates on three fronts: a partnership with the OECD quantifying the ROI of prevention (p. 38); a chapter dedicated to patient engagement and the collection of experience (PROMs/PREMs, p. 93); and specific work on overseas territories, long treated peripherally (p. 70, 139). Operational files are added: deprescribing benzodiazepines, therapeutic de-escalation in oncology, the role of physiotherapists, vaccination for the elderly, daily allowances for work-related accidents/diseases.

The 42 proposals

42-propositions-CNAM-2027.pdf

Axis 1 — Prevention: the battle of the decade

• Prevention at different life stages (mainland) → proposals 1 to 6
• Prevention in the DROM → proposals 7 to 10

Axis 2 — Care pathways and quality of care

• Patient engagement → proposals 11 to 13
• Old age and healthy ageing → proposals 14 to 17
• Hospital organisation (gradations of care, GHT) → proposal 18
• Care pathways in the DROM → proposals 19 to 22

Axis 3 — The right care at the right price

• Medications and oncology → proposals 23 to 26
• Deprescribing → proposals 27 and 28
• Medications in the DROM → proposals 29 and 30
• Economic performance of care providers → proposals 31 and 32
• Physiotherapy and biology → proposals 33 and 34
• Sick leave (AT/MP) and road safety → proposals 35 to 37

Axis 4 — Trajectory, sustainability 2030 and combating fraud

• Securing flows, third-party payment, data exchanges, complementary → proposals 38 to 42

Prevention at different life stages (hexagon) → proposals 1 to 6 in detail 

This chapter is the most directly operational of the report: it describes systems already deployed (school screening, training in mental health first aid, shared care experiments) with their quantified results and concrete barriers. It contains reusable data for local advocacy, transposable action models, and a clear logic — act early, on the determinants, before the onset of pathologies. Useful for arguing, calibrating youth action, or identifying already validated levers. The 5 key points 

1. School screening reveals and corrects social health inequalities : in the year 2024-2025, 43 departments carried out the action; a quarter of the screened children had a disorder, and a year later, 74% of the children identified with a visual disorder and 86% with a language disorder had consulted (p. 45). The rate of anomalies is all the higher as the social position index of the school is low — the link is stronger for language (p. 46).
2. The mental health of young people is deteriorating, with precise data : hospitalisations for self-inflicted injuries increased by 30% among 15-17 year olds between 2021 and 2024; prescriptions of psychotropic drugs for 12-25 year olds are rising by 5.3% per year, reaching 1.04 million patients in 2025 (compared to 792,000 in 2019), with the highest increase among 12-15 year olds (+10%/year) and for ADHD psychostimulants (+23.7%/year) — p. 48-49.
3. Primary prevention in mental health has a quantified return : according to the OECD, a school intervention strengthening students' social, emotional, and cognitive skills could prevent around 4,000 cases of chronic illnesses per year and gain 18 years of healthy life for 100,000 inhabitants (p. 51). Mental health first aid has trained 11,774 people since 2021, with a target of one million by 2030.
4. Ultra-processed food is targeted by new evidence : it accounts for about 35% of caloric intake in France; a Lancet 2025 synthesis (104 publications) shows an association with numerous pathologies in 92 cases. A French trial involving 21,159 participants shows that a label combining Nutri-Score and ultra-processing reporting improves understanding and guides towards healthier choices (p. 55-57).
5. The underdiagnosis of COPD is massive and costly : linked to tobacco in 80% of cases, it affects more than 3.5 million people but 70 to 75% of patients are unaware of their condition; barely 20% of at-risk individuals are screened, with an average of 17 months between the first symptoms and diagnosis. An earlier diagnosis could save up to 100 million euros per year (p. 60-61).

2. KEY POINTS OF THE DOCUMENT

1. The quantification of the return on investment of prevention (OECD partnership) is the most structuring contribution: the Nutri-Score would generate +10 years of healthy life for 100,000 inhabitants per year, cardiovascular prevention +6, with substantial savings (p. 38-44). This is a quantifiable argument directly reusable to defend any prevention project.
2. Early screening in schools is presented as a lever for equity: about one in four children in the first year of nursery school does not benefit from a PMI assessment. The 2024-2025 experiment allowed for the screening of 18,100 children for visual disorders and 11,200 for language disorders, with a quarter presenting a disorder requiring follow-up (p. 45-48). Proposal 4 aims to generalise this screening in schools.
3. The diagnosis in the DROM is unequivocal : infant mortality at 8.0 ‰ (twice that of mainland France), prevalence of diabetes twice as high, sugar content of food products significantly higher (7 g/100 ml on average for certain drinks), participation in screenings lower than the national average (p. 70-91, 139-163). A diabetes plan inspired by La Réunion is proposed (proposal 19).
4. Patient engagement is becoming a conventional axis : the report clarifies the distinction between PREMs (patient-reported experience measures) / PROMs (patient-reported outcome measures) and proposes to include them in the conventional agreements in primary care (p. 94-105, proposal 11). It notes the French delay in peer support compared to other countries.
5. Deprescribing is treated as a care in its own right : systematic reassessment of prescriptions, focusing on long-term withdrawal from benzodiazepines, around the trio of doctor-pharmacist-nurse and in connection with the ANSM (p. 185-198, proposals 27-28). My Psy Support would be open to elderly people on benzodiazepines (proposal 17).

3. ACTION PATHWAYS FOR LOCAL ACTORS

1. Mobilise the ROI-prevention argument (p. 38-44) to support a funding request or local advocacy: the gains in healthy life years per 100,000 inhabitants are concrete figures to reuse in partnership meetings.
2. Build on the model of the Reunion diabetes plan (p. 157, proposal 19) — CPTS, 'going towards' actions, Sophia platforms, local communication ARS/Health Insurance — as a transferable framework to structure a chronic disease prevention programme in a territory.
3. Integrate PREMs and PROMs into quality approaches of its structure (p. 94-105): start with a simple collection of patient experience before equipping the measurement of outcomes, relying on the HAS guides validated in French.
4. Structure early detection in connection with schools and the city (p. 45-48): liberal professionals can coordinate with school screenings; anticipate follow-up pathways for identified children (a quarter of those screened).
5. Decline the trio doctor-pharmacist-nurse on deprescribing (p. 189-198): locally identify poly-medicated patients (notably benzodiazepines in the elderly) and organise a coordinated re-evaluation of prescriptions.
6. Systematically adapt actions to overseas realities if intervening in the DROM (p. 70-91): environmental overexposure, limited healthcare provision, and nutritional disparities impose specific protocols, not a simple hexagonal transposition. Identified unmet need : the availability of psychologists and psychiatrists remains very limited in the DROM (p. 160), which restricts the concrete implementation of mental health provisions.

4. ADDITIONAL REFERENCES

1. OECD — Health at a Glance 2025 / Health at a Glance 2025 (November 2025). International framework for the ROI of prevention and expenditure comparisons; directly informs the CNAM-OECD partnership of the report.
   🔗 https://www.oecd.org/fr/publications/panorama-de-la-sante-2025_2f564c6c-fr.html
2. HAS — Guides for using PROMs in routine clinical practice (published online on 20 March 2024, updated on 28 November 2025). PROMs questionnaires translated and validated in French, directly usable to operationalise patient engagement.
   🔗 https://www.has-sante.fr/jcms/p_3501799/fr/guides-d-utilisation-des-proms-en-pratique-clinique-courante
3. DREES — Health expenditure in 2024, Results of health accounts, edition 2025 (published on 30/09/2025, corrected on 22/12/2025). Independent macro-financial context to situate CNAM projections (current health expenditure: €333 billion).
   🔗 https://drees.solidarites-sante.gouv.fr/publications-communique-de-presse-infographie-documents-de-reference/250930-Panorama-depenses-de-sante

5. FREQUENTLY ASKED QUESTIONS (FAQ)

1. What is the actual level of the deficit and will it be resolved?
   The deficit reaches -€15.9 billion by the end of 2025 and would decrease to -€13.8 billion in 2026, but thanks to new revenues, not a reduction in spending, which remains dynamic (p. 9-10).
2. What is the savings target for 2027?
   €3.9 billion in savings, consistent with the trajectory defined for 2030 (p. 251).
3. What does the partnership with the OECD say specifically about prevention?
   It quantifies the return on investment of targeted actions: the Nutri-Score would provide +10 years of healthy life for 100,000 inhabitants/year, cardiovascular prevention +6, with associated savings (p. 38-44).
4. What concrete innovations are there for children's screening?
   Proposal 4 aims to allow Health Insurance to organise screening for visual and language disorders in schools, following an experiment that screened 18,100 + 11,200 children in 2024-2025 (p. 45-48).
5. What does the proposed patient commitment consist of?
   Collecting patient experience (PREMs) and outcomes as seen by the patient (PROMs), then incorporating this approach into the conventional framework in primary care (proposal 11, p. 94-105).
6. What specific measures are there for overseas territories?
   A diabetes plan inspired by La Réunion (prop. 19), aligning sugar levels with mainland France (prop. 8), strengthening Mon Soutien Psy (prop. 20) and nurse-assisted teleconsultations (prop. 21) — see p. 70-91 and 139-163.
7. What is "therapeutic de-escalation" and deprescribing?
   De-escalation reduces the intensity of a treatment (e.g. oncology) without losing the chance to improve quality of life (prop. 23); deprescribing reassesses and lightens prescriptions, with a focus on benzodiazepines (prop. 27-28, p. 185-198).

6. REWRITING IN EASY LANGUAGE

What is the report?

The Health Insurance has written a large report. It talks about health money. It gives 42 ideas for 2027. The aim is to provide better care. The aim is also to spend better.

There is a money problem

The Health Insurance spends more than it earns. In 2025, there will be a shortfall of 15.9 billion euros. That is a lot. In 2026, it will be a little less. But the problem is not solved. If nothing changes, spending will be too high in 2030.

The solution: prevention

Prevention means acting before the illness. It costs less than treating late. The report proves this with figures. For example, the Nutri-Score helps to eat better. It adds years of healthy life.

Acting early with children

Many 3-year-old children are not checked. They can be screened at school. We check if they see well. We check if they speak well. One in four children needs help.

Listening to patients

The patient knows their illness. We want to ask for their opinion. We want to know how they are doing after treatment. This helps to provide better care.

Helping overseas territories

In the overseas territories, health is more fragile. There is more diabetes. Babies die more often. The report proposes plans for these territories.

7. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy : The Nutri-Score and information on ultra-processed products (prop. 1) explicitly aim to make health information understandable for all.
• Empowerment : Patient engagement (PROMs/PREMs) and peer support place the patient as an actor in their journey, but the report acknowledges the French delay on this point (p. 38, 93).
• Participation : The report was co-constructed with the CNAM Council (social partners, patient representatives, and mutuals); co-construction with patients in primary care is proposed (prop. 11).
• Community health : The collective dimension appears through the CPTS, the ‘going towards’ and territorial plans, particularly in the DROM (prop. 19).
• Ethics : Territorial (DROM) and social disparities are named, but the analysis remains focused on medical-economic efficiency rather than cultural biases.
• Human rights : Equity of access (screening at school, health insurance for all, prop. 42) and attention to disadvantaged territories reflect a concern for inclusion.
• Intersectorality : OECD partnerships, ARS, complementary organisations (coalition of funders), schools, European Union (cross-border tobacco sales) are mobilised.
• Partnership : The coalition of mandatory/complementary health insurance is formalised (p. 253), as is the trio of doctor-pharmacist-nurse for deprescribing.
• Fight against discrimination : The report addresses territorial inequalities and access to care, but does not directly tackle the discrimination experienced in care or the issue of non-judgment.

8. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance — high. Reference institutional source, linked to the National Health Data System (SNDS) and the mapping of pathologies (2024 data), with a methodological partnership with the OECD and international comparisons. The 2030 projections are based on an explicit modelling. Caveat: document produced by an actor who is also a stakeholder in the funding — the proposals carry a direction (control of spending) that should be read as such.

Operational relevance — high. Each proposal is numbered, referenced by page, and often linked to an existing experiment or device (Sophia, My Psychological Support, cavity-free generation). ⚠️ Caveats : (a) these are proposals submitted to parliamentary debate (PLFSS 2027), not enacted measures; (b) the version analysed is semi-finalised (contributions from the Council “to come”, p. 259); (c) slight counting discrepancy to note — 42 proposals are listed in the report while the official communication highlights 40 (the last two carry forward measures from the 2026 report).