

In 2020, the situation in the first few months of the year resulting from the Covid-19 pandemic

led to an exceptional drop in the revenue of social security bodies (-

€27.3bn compared with

the revenue forecast in the financing law adopted at the end of 2019) and an increase in

expenditure (+€11.5bn), mainly in health insurance. The deficit of the general social security

scheme and the Old Age Pension Solidarity Fund (FSV, Fonds de solidarité vieillesse) reached

an unprecedented €44.4bn in 2020. Parliament decided to transfer

a further €136 billion of

social debt to the Social Security Debt Redemption Fund (Cades, Caisse d'amortissement de

la dette sociale).

Even more than the past decade, which saw a slow recovery of social finances after the very

high deficits following the 2008 financial crisis, interrupted however in 2019, the next few years

will be marked by the need to rebuild a sustainable return to balance for the social accounts.

It is with this in mind that this report successively aims to:



to measure

the impact of the consequences of the health crisis on social finances

and

to attempt to shed light on the conditions for their recovery through a retrospective analysis

of the measures taken to control expenditure over the last decade, both in terms of their

effectiveness and their impact on the population and partners implementing health care

(part I);



and in line with the reports of previous years, to continue to illustrate using new examples

the many possibilities for

reconciling the need for quality with the need to control social

expenditure

in the field of health insurance (part II), old age pension insurance, and family

benefits (part III) or the management performance of social security organisations (part IV).

1. A necessary redirection in the progression of

expenditure in order to hold back debt

and return to equilibrium

Chapter I - Constructing the return to equilibrium

Wh

ile 2019 ended with a reduced deficit of €1.9 billion for the general scheme and the Old

Age Pension Solidarity Fund (FSV), the health crisis will lead to an unprecedented

deterioration in the social security financial position.

A deficit of unprecedented magnitude

According to the 2021 Social Security Finance Act (LFSS, Loi de financement

Change in the aggregate deficit of the general scheme and the Old Age Pension

Solidarity Fund (FSV)

(2008-

2020 in billions of €)

IEG: electricity and gas industries

Source: Cour des comptes, according to data from the audit report of the Commission for

the Accounts of Social Security (CCSS, Commission des comptes de la sécurité sociale)

of June 2020

Compared to the 2020 forecast in the 2020 LFSS, revenue is expected to fall by €27.3bn,

or -5.0 % compared to 2019. The private sector wage bill, which is the main tax base for

financing social security, is expected to fall by 7.9 % in 2020 (compared with the 2.8 %

increase forecast in the 2020 LFSS). The economic recession is leading to a decline in

salaried employment. The allowances paid under the partial activity scheme are

replacement income exempt from social security contributions and subject to the

Generalised Social Contribution (CSG, Contribution sociale généralisée) at a reduced rate

of 6.2 %.

2020 general scheme and FSV balances

(2021 draft LFSS, in billions of €)

2019

2020

Actual

(1)

2020 LFSS

(2)

CCSS juin

2020*

(3)

Deviation

from LFSS

(3)-(2)

Variation

2020/2019

(3)-(1)

Sickness

-1,5

-3,3

-31,1

-27,8

-29,7

AT-MP

1,0

1,4

-0,7

-2,1

-1,7

Family

1,5

0,7

-3,1

-3,8

-4,6

Old Age Pension

-1,4

-2,7

-14,9

-12,2

-13,5

General FSV

scheme

-0,4

-4,1

-49,9

-45,8

-49,5

FSV

-1,6

-1,4

-2,1

-0,7

-0,6

Old age pension

+ FSV

-3,0

-4,1

-17,0

-12,9

-14,1

RG+FSV

-1,9

-5,4

-52,0

-46,6

-50,1

Expenditure is expected to exceed the 2020 LFSS forecast by €11.5bn, increasing by 5.5

%

(compared with +2.2 % in 2019). The spending dynamics reflect expenditure under the

National Objective for Healthcare Spending (Ondam, Objectif national de dépenses

d’

assurance maladie), which is expected to increase by 7.6 % (compared with 2.45 % in the

2020 LFSS forecast). As a result of the health crisis itself, the health insurance system will

have to bear a net expenditure increase of almost €11 billion.

In 2020 alone, social debt increased by around €30bn and exceeded €146bn at the end of the

year.

Social security debt (2016-2020, in

€Bn)

2016

2017

2018

2019

2020 (p)

(1)

Negative net position of

Cades

135,8

120,8

105,3

89,1

73,1

(2)

Cumulated total at Acoss

of health, old-age pension,

family and FSV deficits not

assumed by Cades

14,6

20,9

22,7

25,6

71,9

(1)+(2)

Total social debt at

the end of the year

150,5

141,6

128,1

114,7

145,0

Endettement financier net de

l

’Acoss pour les branches du

RG

18,4

24,9

18,7

21,2

n.d.

by at least €50 billion. Cades would then have to organise repayment of this additional debt. If

no new revenue is allocated to Cades, social debt extinction will be postponed beyond 2033.

A necessary redirection of expenditure to prevent the accumulation

of social debt

Both the effects of the health crisis and the commitment to additional long-term expenditure are

likely to make it more difficult to bring the social accounts back into balance.

An increase in revenue allocated to social security seems unlikely, given the high level of

mandatory levies in France and the risks that their increase could present for the economic

recovery.

As a result, a new expenditure trajectory needs to be defined, including a reduction in the rate

of increase compared to that resulting from the multi-year trajectory of the 2021 draft LFSS.

The primary objective of this effort to control expenditure should be to reduce the annual

general scheme and FSV deficit to below the annual repayment capacity of Cades (i.e. slightly

more than €17 billion planned for 2021), in order to curb the increase in the overall debt of the

social security system, taken in the entirety of its components.

This effort should aim to increase expenditure selectivity and effectiveness, particularly in the areas

of health care organisation and health insurance, while ensuring that the quality of care and social

security cover for vulnerable people is maintained.

Opinion on the balance tables and the global social security balance sheet

for the 2019 financial year

The Cour des comptes is tasked with checking the consistency of the balance tables and the

global social security balance sheet for the last financial year, before they are submitted to

Parliament for adoption.

As part of its opinions on these tables, the Cour des comptes ensures that the information

contained therein is consistent with the accounting data, that reciprocal transactions between

bodies have been eliminated and, in general, that the information provided to Parliament is of

a high quality.

The Cour des comptes believes that, subject to certain observations, the tables relating to the

2019 financial year, which will be submitted to Parliament for approval as part of the draft 2021

Social Security Finance Act (PLFSS, Projet de loi de financement de la sécurité sociale),

provide a consistent representation of the revenue, expenditure and balance (balance tables)

and of the assets and liabilities (global balance sheet) of the social security entities included in

their respective scopes.

Chapter II - Health insurance expenditure between 2010 and 2019:

reforms to be stepped up

Voted by Parliament every year since 1997, the National Objective for Healthcare Spending

(Ondam) had never been met before 2010. Since then, and until the health crisis, the Ondam

has become the main tool for regulating health insurance expenditure.

A slowdown in the rate of expenditure growth until 2016 followed by a relaxation

from 2017 onwards

The strengthening of expenditure regulation led to a clear slowdown in annual expenditure

growth until 2016. In six years, the Ondam rate of increase was therefore reduced from 3 % in

2010 to 1.8 % in 2016.

From 2017 onwards, the level of the annual objective was significantly relaxed: the 2018-2022

Public Finance Programming Bill provided for an annual Ondam growth rate of 2.3 % over the

period. For 2019, this rate was raised to 2.5 % for the implementation of the "Ma santé 2022"

plan

1

. Then, even before the health crisis occurred, the hospitals emergency crisis led to an

increase in the 2020 Ondam to 2.45 %.

Despite these end of period changes, the Ondam compared to GDP was stabilised, on a

constant basis, at around 8.3 %.

Ondam in relation to GDP (in %)

1

Annual financial management that is effective overall and should be

maintained

Reducing the scope of goods and services covered by health insurance, as had been done in the

past

2

, has been ruled out as a means of controlling expenditure. The share of health expenditure

borne by households has even fallen slightly (25 % in 2018 compared with 26.4 % in 2010), and

France is still therefore the European country where this is the lowest.

Despite their overall effectiveness in managing health insurance expenditure, the regulatory

techniques implemented have their limitations. In particular, unlike expenditure on hospitalisation or

the medico-social sector, and with the exception of biology, there are no infra-annual regulation

mechanisms to guarantee compliance with the changes in expenditure on outpatient medicine, in

particular the fees paid to private health professionals.

A multi-year programme to improve the quality and efficiency of care

to support the regulatory mechanisms

The implementation of annual financial control tools is not sufficiently backed up longer-term by the

use of the many sources of efficiency and quality in the health system. In addition to the mechanisms

aimed at meeting the annual expenditure target, a multi-year framework for adjustments and

restructuring should be established. These would be monitored over time, under the control of

Parliament, and would be aimed in particular at influencing the conditions under which health care

is provided to the population by health care institutions and professionals.

1.

Put an end to the tightening of income and expenditure in the balance tables, which do not

comply with the normative framework set out by the organic law on the Social Security Finance

Acts for the preparation of the financial statements of compulsory basic social security

schemes (repeat audit recommendation).

2.

Increase the resilience of the trajectories set out in Annex B of the Social Security Finance Act

by backing them up with an analysis of the main variables (epidemiology, productivity gains,

innovation, changes in health care consumption behaviour, demographic changes), as well as

the definition and programming of the actions to be undertaken and carried out in order to ensure

compliance with them while preserving and improving the quality of care.

3.

Improve the quality and rigour of the assessments of the efficiency gains listed in Annex

7 of the Social Security Finance Act and recorded for the latest financial year.

4.

Increase the contribution of outpatient care to the drive to regulate health expenditure, by

setting up a mechanism to compensate for exceeding targets.

2

Chapter III - The evolution of family and pension insurance

expenditure between 2010 and 2019: significant results

Expenditure on family benefits has stabilised

Legal family benefits (excluding housing) have stabilised after having increased at a sustained

annual rate of +2.2 % between the start of the 2000s and 2014.

This evolution was facilitated by a sharp slowdown in the birth rate since 2014 (in 2019, 66,000 fewer

births were registered than in 2014).

But the stabilisation in value of family benefit expenditure is also the result of choices made.

Changes in family benefit expenditure* (in

current €Bn)

* Excluding housing since 2006 and excluding the single-parent allowance (API,

Allocation de parent isolé) and the disabled adults' allowance (AAH, Allocation aux

adultes handicapés) until 2009,

Source: Combined financial statements for the family branch (2006-2019)

Acknowledged choices

The annual benefits revaluation has been set at levels below that of inflation: from 2016 to

2019, the monthly base for family allowances (BMAF, Base mensuelle des allocations

familiales) increased by 1.7 % for an inflation rate of 4.3%.

Several reforms have had the effect of differentiating support for families with young children

according to their income. Family allowance expenditure has also been stabilised and the

amount now varies: the amount of family allowance paid to the 472,000 families exceeding

certain income thresholds (i.e. 10 % of recipients at that time) has been divided by two or four.

Other reforms concerned childcare benefits with the aim of limiting the length of parental leave

taken by each parent in order to encourage women to return to work and to encourage the

sharing of leave time between the two parents.

Some of the benefits intended for the poorest families have been increased, sometimes

significantly, since 2013: +€653M (+39

%) for the family supplement, in particular with a 50 %

increase in the family supplement for the poorest large families, +€469M (+

36 %) for family

support allowance, whose 750,000 recipients saw their benefit increased by 27.5 % between

2014 and 2008, and +€77M (+35

%) for allowances for disabled children.

The rate of increase in pension expenditure has been significantly reduced

by successive reforms

Over the past twenty years, the pension system has undergone five major reforms affecting

basic pensions, in 1993, 2003, 2008, 2010 and 2014. In addition to increases in contributions,

these reforms affected the retirement age and the level of pensions, according to different

measurements. The ratio of pension expenditure compared to GDP rose sharply between

2002 and 2014, from 11.7 % to 14.1 %, before stabilising at around 14 %.

Pension expenditure compared to GDP

with and without the basic pension reforms since 1993

Sources: A. Marino, Insee, 2014; Retirement Guidance Council (COR, Conseil

d'orientation des retraites) report, November 2019

Note: forecasts based on the assumption of productivity gains of 1.3 % per year in the

long term.

The successive pension reforms since 1993 and since the end of the 1980s, the indexation to

inflation of the elements used to calculate the pension and its subsequent revaluations, have

helped to stabilise the share of expenditure going to compulsory schemes in the GDP.

However, the average standard of living of pensioners by comparison with that of the general

population remains slightly over 100 % (105 % in 2018).

The contrasting effects of measures relating

to the legal age or the contribution period

Among the levers established by the reforms, the extension of the insurance period required

to benefit from the full rate had a long-lasting but gradual effect whereas, on the other hand,

raising the legal retirement age had a significant short-term effect that decreased over time:

raising the legal retirement age would therefore contribute to the expenditure savings linked to

all the reforms since 2010 to the tune of 80 % in 2020, but only one-third in 2040.

Summary of the effect of each measure implemented since 2010 on

pension resources provided by all schemes (in GDP points)

Source: H. Martin, « Impact des réformes de 2010 à 2015 sur les masses

financières des régimes de retraite », Drees, December 2016.

Graph legend : Decree of 2 July 2012 (early retirement) - Raising the age of entitlement from 60 to 62

(Law of 9 November 2010) - Raising the age for cancelling tax relief from 65 to 67 (Law of 9 November

2010)- Increase in the period of insurance required to obtain the full rate (Law of 20 January 2014).

Set of Agirc/Arrco National Interprofessional Agreements- Other regulatory changes (LURA (Single

Liquidation of Aligned Regimes), capping of MICO, reform of Ircantec (Institution of Supplementary

Pension for Non-Permanent Employees of the State and Public Authorities),offsetting the date of

pension revaluations...)

Employees with low incomes or who have suffered periods of unemployment

are more affected by the reforms

However, these reforms have an impact in terms of equity between generations and between

categories of insured persons.

Changes by generation in the length of time spent in retirement, as well as the replacement

rate (average amount of pension in relation to average income from work), make it possible to

assess this notion of equity. The youngest generations would benefit from an improvement in

the length of time spent in retirement; on the other hand, the average amount of pension

compared with average working income, or average replacement rate, would fall from 55% to

45% between the 1950 and 1990 generations.

Retirement duration as a proportion of life expectancy

Graph legend: Central mortality scenario - High mortality variant-

Low mortality variant

Source: COR annual report, June 2019

Finally, pension reforms have also sought to mitigate the effects on insured persons with low

pensions: increase in the minimum contribution for quarters contributed (2004), reduction in

the salary required to validate a quarter in the general scheme (change in 2014 from 200 to

150 hours on the minimum growth wage, enabling a one-third time employee paid at the

minimum growth wage to validate four quarters per year), etc.

Impact of the reforms by salary level

Graph legend: All the reforms carried out between 2010 and 2015- Average length of retirement - Out

of Employment -Low salaries -Medium-low salaries -Medium-high salaries - High salaries -Average

accumulated pension over the life cycle

Source: EIC 2009, modèle TRAJECTOIRE, DREES. COR macroeconomic Scenario B from the

December 2014 session.

Insured persons on low salaries or who left employment early have, however, been more

strongly impacted by the indexation of the salaries used to calculate pensions using prices,

which favours insured persons with a full and ascending career, generally on a high salary. In

the long term, for the 1980 generation, the total pension loss linked to the post-2010 reforms

would be more than 10% for insured persons outside the labour market from the age of 50,

compared with 3.4% for those with high wages.

2. Improving the efficiency of our health care

system

Chapter IV - Deepening the territorial reorganisation of the public

hospital using Regional Hospital Groupings

Since 2016, all public hospitals must be members of a Regional Hospital Grouping (GHT,

Groupement hospitalier de territoire). The GHT is an entity without legal personality set up for

ten years around a shared medical project in which one of the hospitals, known as the support,

manages the shared functions. The objectives of this reform were twofold: to improve the

population's access to quality hospital care, graded according to patients' needs, and to research

more economical management by pooling activities between hospitals within the same GHT.

Regions deprived of certain types of care

The territorial branch of the GHTs should have helped to correct inequalities in access to care

across the territory. In practice, it has led to the creation of haphazard GHTs with too few health

establishments to actually achieve the objectives of the reform.

A significant number of GHTs do not offer certain types of care to the population: this is the case for

partial inpatient obstetrics (practised in only 90% of GHTs), psychiatry (79% of GHTs) and

home care (54% of GHTs). The same is true for medical-technical facilities: while almost

all GHTs offer access to MRI and CT scanners or an operating theatre, interventional

activities (angioplasties, heart rhythm procedures, defibrillation, thrombectomies, uterine

embolisations, etc.) are very unevenly represented.

With regard to the management of serious and urgent illnesses such as strokes (CVAs) and

myocardial infarction, it would seem that 24 GHTs do not have a neuro-vascular unit (NVU).

Furthermore, 38 GHTs do not have a coronary angioplasty unit. In total, 35% of the GHTs do

not offer specialist consultations for these two illnesses, forcing these groups to resort to

cooperation with private establishments outside the GHTs, which flies in the face of the

objectives of the reform in terms of equal access to quality public care.

Medical pooling initiatives that have not been successful

In areas heavily affected by inadequate medical demographics, the forming of GHTs could

have played a useful role by bringing together establishments which suffer from a lack of

medical resources with better equipped establishments likely to provide them with assistance

within the same group. However, among the GHTs located in the 10 départements

3

most

affected by unpropitious medical demography, only Creuse has been attached to a GHT with

a university hospital, which partially mitigates these inequalities. On the other hand, the

départements of Yonne and Seine-et-Marne, both in critical situations, have been segmented

into five GHTs which makes it more difficult to provide mutual assistance.

Pooling and cooperation arrangements between GHT establishments are still underdeveloped:

the shared medical projects, which determine the GHT's strategic guidelines in terms of

healthcare for the period 2017-2022, are not likely to bring about any in-depth changes in the

organisation of healthcare. Two-thirds of the mutual aid projects between members maintain

the organisations already in place and the autonomy of the medical and healthcare teams in

each establishment. Only a minority of the shared medical projects pursue an integration

objective. Out of the 1,902 healthcare sectors analysed by the Cour des comptes within the

129 shared medical projects available, only 99 sectors (5.2%) provide for the creation of an

inter-establishment centre in the short or medium term. Actions resulting in departmental

alignment are very rare: 23 out of the 1,560 medical-surgical fields analysed.

Governance that requires streamlining

GHTs have not been given legal personality. This is detrimental in terms of operational

adaptability and use of resources. They operate with an unreasonable number of governing

bodies, which makes the decision-making process considerably more cumbersome.

4

On the other hand, GHTs with a shared management (35% of GHTs) have effective dynamics,

often leading to the merger of the group's establishments.

3

In order of increasing criticality of the indicator for changes in medical density between 2007 and 2016: Ain, Eure,

Mayenne, Seine-et-Marne, Dordogne, Gers, Creuse, Cher, Indre and Yonne (source: Ordre national des médecins,

Atlas de la démographie médicale pour 2016).

4

5.

Swiftly review GHT scopes so that all of them can constitute a consistent and minimal public

offer

(Ministry of Health, Regional Health Authority (ARS, Agence régionale de santé)).

6.

Set up, at ARS and hospital community initiative, reinforced common directorates and

encourage, where possible, the member establishments of a GHT to merge to form a single legal

entity (

Ministry of Health

).

7.

In order to reinforce local links within each region, entrust the health establishments that are

members of GHTs and particularly local hospitals with the implementation of the group's

strategy as closely as possible with health professionals, elected representatives and the

needs of the population

(Ministry of Health, ARS).

8.

Reinforce reform monitoring both at national and regional level and manage group action

monitoring in a more operational manner via an amendment to the constitutive agreements,

setting out objectives and performance indicators

(Ministry of Health, ARS).

Chapter V - Migac and Fir financing specific to the health care

system: simplify and redefine the roles of the central administration

and the ARS

Health establishments, whether public or private, have been financed since 2004 according to

their activity on the basis of per-stay rates. However, residual funding by allocations known as

"Missions of General Interest and Contractualisation Aid" (MIGAC, Missions d'Intérêt Général et

d'Aide à la Contractualisation) is intended to compensate for specific costs. In addition, since 2012,

the Regional Health Authorities (ARS) have had "Regional Intervention Funds" (FIR, Fonds

d'Intervention Régional), which mainly finance public health actions of regional interest for the most

part through assistance to health establishments or associations.

In 2019, these two sources of funding represented a total of nearly €11 billion.

Too complex and very un-user-friendly mechanisms

The survey performed by the Cour des comptes shows the existence of overlaps between the

different financial packages, ministerial management instructions that do not allow ARS to direct

funding sufficiently based on an assessment of needs as close to reality as possible, and

increasingly stacked budget lines some of which are for small amounts and difficult for health

establishments to understand.

The number of General Interest Missions (MIG, Mission d’intérêt général) has continued to increase

and reached 78 different lines in 2019, while almost a third of the MIG budget was used to finance

three missions in 2019: mobile emergency and resuscitation structures (SMUR, €833M),

emergency medical aid services (SAMU, €249M) and the care of patients in vulnerable situations

(€192M).

The Regional Intervention Fund (FIR) in itself is a response to the objective of providing the

ARS, which were created in 2009, with a financial intervention instrument to promote, in the

words of the law, different "actions, experiments and, where appropriate, structures

contributing to five types of missions". In practice, two actions account for more than a third of

the amounts liquidated in 2019: permanent care in health establishments, amounting to

approximately €701 million, and investment aid other than national plans, amounting to nearly

€541 million.

Simplification of these measures and a clearer division of responsibilities between the central

administration and the ARS are essential to improve the effectiveness of public action and reduce

the cost of management.

Significant disparities between regions

There are significant disparities between regions, as shown on the map below.

Amount per capita 2014-2019 of the MIGAC and FIR regional allocations,

excluding non renewable credits (in €)

I

Source: Cour des comptes

Support for institutions in difficulty and investments

A significant part of the credits, estimated at around €700M, was used in 2018 to support

institutions in difficulty: €661M in support for contractualisation and around €57M financed by the

FIR. In practice, the bulk of the aid benefits a few public health establishments in chronic deficit

in mainland France but, above all and to a significant extent, in Corsica and overseas France.

To support some of their investment projects, the health establishments receive aid, mainly for

operating costs, to cover their additional financial expenditure. This aid is administered within the

framework of the MIGAC or FIR package. This very significant investment support is expected to

reach just over €1.5 billion in 2018: €892 million under the MIGAC and €614 million under the FIR.

It also seems that the medical and care teams within the institutions are not always informed

of the existence of this funding or its correct allocation.

Finally, the granting of funding by the ARS is not always subject to sufficiently rigorous internal

control.

ARS monitoring of investments made by health institutions is also very inadequate.

Reducing the number of MIGs and giving ARS more room for manoeuvre

All in all, it would be justified to reserve the use of the MIGAC allocation to finance the few

missions that are intended to apply to the whole country, subject to being allocated in accordance

with national rules both for the amounts paid and for the recipients.

The financing of all other

missions should be transferred to the Regional FIRs and would thus be delegated to the ARS,

which would be responsible for determining the allocation criteria appropriate to the regions.

9.

For the MIGACs, reduce and revise the list of MIGs; switch those that do not respond to any

specific national issue as well as regional contractualisation aids to FIR

(Ministry for Social Security)

.

10.

For the FIR, define an enforceable internal control reference framework to ensure the

efficiency of the actions financed

(Ministry for Social Security).

11.

Ensure overall and per-operation monitoring of investment support expenditure

(Ministry

for Social Security).

12.

Ensure that MIGAC funds for health care activities are properly allocated and that they are

visible to the medical and health care teams concerned

(Ministry for Social Security).

Chapter VI -Regulate the expenditure and prescriptions of medical

devices more actively

Health insurance finances a huge range of health products in the category of medical devices.

Ranging from simple dressings to high-tech implantable devices, they are used in the

outpatient treatment of a growing number of diseases or in health or medico-social institutions.

Reimbursement of outpatient products and services

(2018, in %)

Source: Cour des comptes calculations, CNAM

Chart legend: Treatment of respiratory diseases (including sleep apnoea) - Devices for diabetes self-

monitoring and self-treatment

–

Dressings - Oral Nutrition - Non-coded orthotics (small devices) -

Medical beds - Genitourinary, incontinence and bladder catheterisation equipment - Respiratory

treatments, other services - Non-coded ortho-prosthetics

–

Wheelchairs - Optics, lenses and frames

Mass-produced orthotics- Drips, active systems, non-implanted pumps - Enteral nutrition, bags and

service provision - Hearing aids

–

Other

Dynamic expenditure

Expenditure, estimated

to be around €15 billion, has been growing at a slower rate in recent years,

but remains more dynamic than overall spending: outpatients spending grew annually by 4.4%

between 2016 and 2019. This growth can be explained in particular by the increase in volumes

consumed for a few classes of devices, related to respiratory diseases, blood sugar disorders,

nutrition and dressings.

Inpatient expenditure is also increasing: +3.1% on average between 2014 and 2018, due to certain

implantable medical devices financed in addition to hospitalisation rates, and sterile medical devices

financed by hospitalisation rates.

Changes in medical device expenditure

Chart legend: Outpatient expenditure - Extras list expenditure - Public hospital expenditure

not included in the extras list

Source: Cour des comptes

Savings targets not met

The annual savings targets, set out within the Social Security Finance Act, have risen sharply:

from €50m in 2015 to €280m in 2019 and 2020. However, since 2019, the Economic

Committee for Health Products (CEPS, Comité économique des produits de santé), the

interministerial body responsible for negotiating the prices of health products, has been

experiencing increasing difficulties in achieving the savings targets for outpatient prescribed

devices.

The volume reduction targets set by the health insurance scheme have only represented a

quarter of the overall savings effort expected. With the exception of the year 2017, the results

obtained have remained below the targets.

Annual savings targets and annual savings met

for medical devices (2015-2019)

M€

2015

2016

2017

2018

2019

CEPS

: price reduction targets

Savings achieved

50

47

70

46

90

71

140

140

200

172

Health insurance

Health insurance:

medical control objectives

Savings achieved

-

-

-

-

40

131

40

0

75

22

Total objectives

Savings achieved

50

47

70

46

130

202

180

140

275

194

Achievement rate

94 %

66 %

155 %

78 %

71 %

Source: Cour des comptes

Actions to be strengthened in the area of health insurance control

The intensity of the "medicalised control" of volumes needs to be sharply reinforced, alongside

an increase in price reductions.

In order to be fully effective, the efforts required from the many stakeholders in the sector

(manufacturers, distributors, service providers, prescribers...) would benefit from being part of

a multi-year framework. The Ministry of Health and Social Affairs must also be more active in

managing the various lists of devices registered for reimbursement. Lastly, health care

institutions must continue their efforts to optimise their purchases of medical devices.

13.

To deepen public authorities' knowledge of the sector, in particular by improving the

completeness of the statistics on the consumption of medical devices and the dynamics of

expenditure

(Ministries of Health, Social Security and Social Cohesion, CNAM, ATIH).

14.

Establish a multi-year trajectory for the evolution of expenditure on medical devices, based on

a plan to revise classifications and reduce the list of "extras" with the aim of reducing rates

(Ministries

of Social Security and Health).

15.

Develop a multi-year strategy for structuring and professionalising medical device

purchases supported by methodological tools for health establishments enabling them to

obtain price reductions during negotiations

(Ministry of Health).

16.

Mobilise all risk management tools, by linking them with objectives to achieve greater savings

for inpatient and outpatient medical device expenditure

(CNAM)

.

3. Some solidarity expenditure must be better

targeted

Chapter VII - Harmonising, simplifying and better managing

minimum pensions

Most pension schemes have internal solidarity mechanisms known as minimum pensions, the

aim of which is to raise the pension paid to some of their policyholders to a minimum amount

under certain conditions. They are contributory (the insured person must have contributed for

the equivalent of a full career, i.e. without tax relief) and are intended to intervene upstream of

the general safety net constituted by the "minimum old-age pension".

As a minimum: a significant supplement for small pensions

The minimum pensions concern approximately one new pensioner in five. The amount of

additional pension paid out in this respect was estimated at €8.7 billion in 2018. The pension

increase linked to the minimum pensions represents an average of around €130

per month for

new pensioners who benefit from them, whether they are insured under the general or civil

servant (excluding military) scheme. The average amount of the minimum pension paid by the

Agricultural Social Mutual Fund is lower, around EUR 80.

Theminimum pensions bring the amounts of their recipients' pensions closer to those of other

pensioners. For new general scheme pensioners in 2018, the ratio between the average pension

of recipients of the contributory minimum and that of other new pensioners was around 70%; it

would have been around 50% without the contributory minimum. In 2016, recipients of the

minimum pension had a total pension from all schemes in 2016 that was on average 38% lower

than that of other pensioners, the difference being of the same order of magnitude for women and

men.

In order to benefit from the minimum under the general scheme, the total monthly sum of the

basic and supplementary pensions, after taking into account the different minimum pensions

paid by these schemes, must not exceed a capping threshold slightly below the net monthly

minimum growth wage, i.e. EUR 1,191.56 per month on 1

st

January 2020. If this amount is

exceeded, the minimum is capped proportionally. This capping mechanism also applies to the

agricultural m

inimum but with a lower ceiling (€871.27). In practice, it is not applied to civil

servants.

Changing characteristics of recipients

The introduction of the capping rule in 2012 has reduced the proportion of new pensioners

whose pension is raised to the minimum contribution under the general scheme (Mico): the

proportion of persons whose pension is raised to a minimum has thus gone from 43% in 2008

to 24% in 2012 and to 18% in 2016.

Share of pensions raised to the minimum in the year's settlements

Chart legend: Non-salaried MSAs - State civil service

–

General regime

–

National Pension Fund for Local Government Employees

Source: Cour des comptes based on data from the schemes

The minimum contribution no longer guarantees for the generations currently retiring that the

total pension paid to a pensioner who has had a full career at the minimum growth wage will

be equal to 85% of the minimum growth wage, which was the initial objective. It now mainly

benefits people with part-time or incomplete careers. It does not guarantee that the level of

pensions paid is, in all cases, higher than the minimum old-age pension: where the basic

pension, including the minimum contribution and plus the supplementary pension, is lower than

the minimum old-age pension, the minimum old-age pension may be paid in addition in the

absence of other household resources. Therefore, in 2016, 9% of pensioners receiving a

minimum pension under their main scheme were also receiving the minimum old-age pension.

Of the minimum old-age pensioners, 67.4% were receiving a minimum pension under their

main scheme (of which 78.3% were women and 59.4% men).

Unjustified differences in rules between schemes and detrimental management

malfunctions

The minimum pensions are subject to complex rules, which differ from one scheme to another.

The eligibility conditions for the three main schemes, the minimum contribution for the general

scheme (Mico), the guaranteed minimum (Miga) for civil servants and the minimum reference

pension (PMR, Pension minimale de référence) for farmers have been gradually brought closer

together, but this harmonisation remains incomplete and there are still significant differences

between them. The capping rule, which implies knowing the amount of pension received under

each of the schemes, creates significant interdependence between schemes. This means that

in practice, as of 31 December 2018, due to insufficient coordination between pension

schemes, almost half a million people who had retired and were potentially eligible for the Mico

provided by the general scheme had files permanently pending final settlement, a situation

likely to deprive some of them of this income supplement. The Cour des comptes also

highlights the unfair situation resulting from the failure of the civil service pension schemes to

apply the capping rule, to which they are nevertheless subject by law.

All in all, the Cour des comptes considers that the sustainability of the minimum pension

schemes requires the objectives assigned to them be clarified along with the rapid re-

establishment of their management.

17.

Implement the provisions of the law of 9 November 2010 subjecting the Miga to conditions

of subsidiarity and capping.

18.

Harmonise the payment of the different minimum pensions with regard to premium and

reversionary right.

19.

Reduce the inventory of cases awaiting the final calculation of the Mico.

20.

Improve information on the minimum pension schemes by enhancing communication for

insured persons who do not liquidate their pension at the full rate.

Chapter VIII - Increasing the impact of social action expenditure in

the family branch

In addition to family benefits, which are rights for the recipients of family branch benefits,

enforceable and guaranteed by law, the Family A

llowance Fund (CAF, Caisse d’allocation

familiale) provide financial and technical support for the development of services and facilities

for families (nurseries, leisure centres, etc.). Social action takes place within a relatively flexible

legislative and regulatory framework which enables a wide range of interventions: early

childhood action, support for families and the parental function, prevention of exclusion,

support for young adults, free time and holidays for children and families.

Expenditure on

social action has been heavily enlisted from 2012 onwards, rising from €4.7

billion to €5.8 billion in 2018 (+€1.1 billion), i.e. a much faster increase than that of expenditure

on family benefits, the trend of which has been stabilised. The main purpose is to facilitate

families' access to collective childcare facilities with a view to encouraging the employment of

mothers of young children.

Nominal changes in expenditure by the National Social Action Fund

(FNAS, Fonds national d’action sociale),

statutory family benefits (excluding housing)

and GDP (base 100 in 2012)

Chart legend : Statutory benefits from the family branch (excluding housing)

GDP - FNAS

Source: Cour des comptes

Two major sectors accounted for 82% of spending in 2018: childcare for young children aged 0 to

6 represents 60% of expenditure and child and family leisure time represents 22%.

Highly distributive aid

In addition to the participation of the families, the CAFs finance at least two thirds of the hourly cost

price of the nurseries. In order to benefit from this funding, establishments must apply the national

family contribution scale, which is highly modulated according to family resources and varies

according to the number of dependent children. This system therefore promotes redistribution

towards the least well-off families.

The redistributive effect of family branch social action on

own contributions to nursery

Own contributions for families with one child in a nursery financed by the social action of the family

branch depend on the level of income. In 2019, for a dual-income couple with an income equivalent

to two minimum growth wage earners and a dependent child under the age of 3, the cost of

institutional childcare for young children (€1,553 per month) will be financed at 46% by the local

authorities, 39% by the CAF and 6% by the State, with the remaining 9% (€138 per month) paid by

the family. For a single parent or a dual income couple with an income equivalent to the minimum

growth wage, the remaining expenditure is 4% (€58 per month) and CAF funding accounts for 47%.

On the other hand, for a couple with an income equivalent to six minimum growth wage payments,

the balance is 27% (€423 per month) and CAF funding accounts for 21%.

However, despite significant progress in the organisation of social action management, the family

branch is struggling to find the levers to ensure greater efficiency in its actions to help families.

Outcomes falling below the objectives

Despite the increase in financing, the branch has not been able to achieve the objective of

creating 100,000 new nursery places between 2013 and 2017. Only 62,500 net additional

collective childcare solutions have been put forward, i.e. a 63% implementation rate.

Nor has the family branch managed to correct regional inequalities, which was one of the

objectives set for it. The proportion of places created in the least well-off regions remains

insufficient, due in particular to the lack of a detailed assessment of needs and of legal

instruments to locally regulate the creation of the various types of childcare structures.

Aid for childcare for young children in 2018

(per child per département)

Map legend: Social action expenditure on early childhood care per child (0-4 years) 2018 per department - From

€354 to €692 per child

-

From €693 to €913 per child

-

From €914 to €1,624 per child

€2,808 per child (Paris)

Source: Cour des comptes

Expenditure on social action relating to the care of young children as a proportion of the 0-4

year old population varies greatly from one département to another. In 2018, four départements

had an average expenditure of over €1,400 per child, with Paris (€2,808) and Hauts

-de-Seine

(€1,624) accounting for the highest expenditure, and 34 départements with expenditure of less

than €700, with Mayenne (€388) and Aisne (€354) accounting for the lowest. The median

expenditure per child (0-

4 years old) on childcare for young children rose from €567 in 2013 to

€791 in 2018. However, the absolute gap to the median increased between 2

013 and 2018 for

most CAFs at both ends of the scale.

Finally, as a result of the reforms in school schedules, the family branch is increasingly involved

in the financing of extracurricular childcare and school support services. This expenditure

represents

€1 billion per year, i.e. more than 15% of social action expenditure. The intervention

of the family branch contributes to the confusion arising from the number of educational support

programmes. Its funding is paid out without any particular pattern for targeting specific regions

or people.

21.

Measure families' childcare needs more precisely by region in order to better direct funding.

22. 

Give the CAF and the local authority concerned the power to authorise the installation of

any early childhood childcare facility.

23. 

Initiate a programme of evaluation of the various social action schemes.

24.

 

Reduce the involvement of the family branch in educational support measures.

4. Improve efficiency

and the quality of management

Chapter IX - Reducing the amount of errors affecting the payment of

social benefits

As part of the certification of the four branches (sickness, accident at work or occupational

disease,

5

family and old age) of the general scheme, the Cour des comptes examines each

year the degree of compliance of the social benefits paid with the applicable legal rules. The

financial stakes are quite hi

gh: in 2019, €403 billion in statutory benefits were paid to more

than 60 million recipients.

At least €5 billion of errors due to benefit or fund recipients

For the financial year 2019, the Cour des comptes identified at least €5 billion of errors of a

definitive type, all branches combined this is an amount in absolute terms, which adds up without

compensating for errors that are advantageous and disadvantageous to benefit recipients.

There are several kinds of error. They may come from data declared by benefit recipients; if

the errors are intentional in nature, they are fraudulent

6

. They may also result from data

processing errors by the funds themselves.

On the one hand, the errors correspond to overpayments to the detriment of public finances.

This is the case for 90% of the amount for errors resulting from data declared for the payment

of family branch benefits, 90% of those relating to invoicing by self-employed health

professionals and private profit-making establishments and 60% of those relating to daily

allowances. On the other hand, they correspond to underpayments to the disadvantage of

benefit recipients; this is the case for two-thirds of the amount for errors affecting the allocations

of retirement pensions.

5

6

Definitive errors affecting benefits paid by

the funds of the general social security scheme

Field

Frequency of

the errors (as

a % of the

number of

benefits)

In €bn

Financial scope of errors (aggregating errors advantageous

and disadvantageous to benefit recipients)

En Md€

As a % of the amount of benefits

Family branch*

3,3*

Errors related to the reporting data used to

award benefits

(unadjusted 24 months after their payment in

2018**)

-

3,3

4,9 %

Errors relating to transactions carried out by

the CAFs in 2019 (not corrected 6 months

after payment)

4,9 %

1,2

1,65 %

The sickness and accident at work or

occupational disease branches

1,4

Errors affecting the settlement of health

insurance costs in 2019

7,5 %

1,0

1,3 %

Errors affecting newly awarded daily

allowances in 2019

10,0 %

0,4

3,0 %

Retirement branch

0,3

Errors affecting pensions paid out in 2019 for

awards between 2012 and 2019

Total

-

0,3

0,3 %

Total

5,0

* This sub-total is calculated as the higher of the two indicators for the family branch, since some of the errors

made by the CAFs relate to data that are themselves erroneous. It is therefore a smaller proportion of the total

amount of errors.

** Undue payments not linked to fraud are statute-barred after 24 months.

Source: Cour des comptes (2019 financial statements audit for the general scheme).

Increasing numbers of errors

Errors have increased sharply in recent years.

Between 2016 and 2019, the proportion of pension benefits affected by a financial error

increased from 11.5% to 15.3%. Their financial impact doubled going from 0.9% to 1.8% of the

amount of newly awarded benefits. For the family branch, the financial impact of definitive

errors

7

on benefits paid linked to data declared by recipients reached €3.3 billion in 2018

compared with €2.0 billion in

2014. The amount of errors related to the CAFs’ own operations

(not corrected at 6 months) increased from €1.0 to €1.2 billion between 2016 and 2019.

The amount of errors affecting the procedures, services and goods invoiced by healthcare

professionals an

d institutions, i.e. €1 billion in 2019, is clearly underestimated.

Reducing manual data entry and acquiring data from third parties to benefit

recipients

Benefit recipients' declarations and internal management processes within the funds need

to be digitalised in order to reduce errors linked to manual entries made by the funds. For

the CAFs, the digitalisation of declarations and supporting documents has made significant

progress, reaching 50% in 2019. However, in 2019, only 24% of the documents submitted

by CAF recipients were processed automatically.

Wherever possible, the provision by trusted third parties of the data required for the payment of

benefits should be preferred to declarations made by the benefit recipients themselves. From

1

st

January 2021, the family branch will base housing benefits on resource data provided by the

employers of wage-earners, other social bodies and the Public Finances Directorate General.

It will then extend this system to the activity premium, then the Inclusion income support (RSA)

and other benefits. However, the timetable for these extensions has not yet been ruled on.

Health insurance must now rapidly offer health professionals and institutions solutions for the

digitalisation of medical prescriptions, which eliminate some of the risks of unjustified

discrepancies between invoices for medical procedures, services and goods and prescriptions,

which are in principle the cause of these discrepancies.

Stepping up controls and allocating more resources to them

Currently too limited, automated consistency controls for the data taken into account for the benefits

payments must be formalised in order to

a priori

stop errors. In particular, the health insurance

system must deploy automated checks that prevent

a priori

settlements to professionals and third-

party institutions paying for invoiced data that do not comply with existing rate classifications.

For all social security branches, a systematic automated reconciliation of recipients' bank

details with the bank account file of the Public Finances Directorate General should be

carried out.

Furthermore, manual operations carried out by the staff of the social security funds should be

subject to more effective

a priori

internal controls, even though these controls are often optional

or partial and the social security funds do not systematically make the necessary corrections

following the detection of errors.

Finally,

a posteriori

documentary and on-the-spot controls need to be reinforced. The invoicing

of fictitious care procedures to the sickness branch, the inaccuracy of declarations of resources

or marital status for the payment of benefits by the family branch or actual residence in France

are not sufficiently checked. The funds need to devote more human resources to these controls

to reinforce them.

Chapter X - Make the necessary changes to the fund networks of

the benefits branches of the general scheme in order to improve the

quality of management while keeping costs under control

The missions of the four branches (sickness, accident at work or occupational disease, family

and old age) of the general social security scheme are implemented by 223 local funds,

comprising 118,000 employees in 2018 and managed by three national public institutions: the

National Family Allowance Fund (CNAF, Caisse nationale des allocations familiales), the

National Health Insurance Fund (CNAM, Caisse nationale de l’assurance maladie) and the

National Old-

Age Pension Insurance Fund (CNAV, Caisse nationale d’assurance vieillesse).

The main categories of funds are the Primary Health Insurance Funds (CPAM, Caisse primaire

d’assurance maladie

- 101 funds in 2018) for the sickness and the accident at work or

occupational disease branches, the Family Allowance Funds (CAF - 99 funds) for the family

branch and the Pension and Occupational Health Insurance Funds (CARSAT, Caisse

d’assurance retraite et de santé au travail) for the old

-age pension, sickness and accident at

work or occupational disease branches.

The fund networks of benefit branches

The lack of recent adaptations of the fund networks

In recent years, a growing proportion of the activities of local funds have been pooled: national

missions carried out by certain local funds, temporary mutual assistance services between

funds or permanent pooling of activities between funds. In the health insurance sector, the

proportion of pooled employees has more than doubled since 2015 and reached nearly 18%

in 2019. This proportion has quadrupled in the old-age pension branch over the same period

(9% in 2019).

This increasing pooling has helped to limit the growing differences in activity levels between

funds. However, it has only partially remedied the excessive differences in size and operating

results.

CAFs and CPAMs, in particular, manage populations of insured persons and beneficiaries of

very different sizes: a quarter of the activity is concentrated in a few very large funds, but another

quarter is provided by a great number of small funds: 54 CPAMs, 55 CAFs and five CARSATs. The

territorial networks of the branches of the general scheme have in fact not been adapted to the

different population trends in the different regions. Between 2014 and 2018, the reduction in the

number of physical sites within the funds mainly concerned public reception points, but very little

their administrative departments. There has been only one fund merger since 2015.

This territorial stability is mainly explained by the obstacles to geographical mobility

ofthe agents, in particular through the memoranda of understanding that accompanied the

latest major merger operations in the family and sickness branches in 2010-2011.

Territorial organisation not efficient enough

On average, the unit production costs of the smallest funds, located in small and medium-sized

conurbations, are higher. Smaller units are less able to help employees specialise and are

more vulnerable to absences. They often have a higher management ratio. Irreducible support

functions generally carry a higher weight.

Conversely, some large units face other types of difficulties. In particular, the Ile-de-France

and Rhône CPAMs are struggling to meet the targets set for them by the CNAM, and four of

the largest CAFs have processing times that exceed the national target. These funds have

higher internal coordination costs and a sometimes high turnover rate for agents, particularly

in the case of telephone platforms, can have destabilising effects since the funds have to

continuously replenish their production capacity.

The current organisation of the networks into a large number of funds and sites does not

ensure the most efficient use of social security human resources. In sparsely populated

départements, mergers of funds appear to be indispensable. In this respect, the creation of

shared CAF-CPAM funds within the same départements seems to be reserved for individual

situations. On the other hand, the establishment of interdepartmental CAFs and CPAMs should

be encouraged in order to provide a critical mass of activities for the maintained funds.

Bringing the social and medical departments of the health insurance scheme

closer to the basic health insurance funds

Lastly, more specifically, the organisation of part of the health insurance activities should be

reviewed. The social department, which today comes under the CARSATs, and the local levels

of the health insurance medical department, which are a decentralised department, should be

attached to the various CPAMs. All activities relating to occupational hazard carried out as

CARSAT should also be attached to the CPAMs since the primary health insurance funds

already provide recognition and compensation for accidents at work and occupational disease.

These developments would make health insurance more effective for both health professionals

and insured persons, particularly in preventing the risk of professional exclusion.

25.

Redefine the missions carried out by all the social security funds, specialising them in

managing a more limited number of processes, implementing local partnerships and proposing

changes to management tools and procedures

(Ministry for Social Security and General

Scheme National Funds)

.

26. 

Strengthen local fund networks by creating, particularly in sparsely populated areas,

interdepartmental funds by branch, or exceptionally interbranch departmental funds, and

better redistribute the activities of large funds whose quality of service has deteriorated

towards those with satisfactory performance

(Ministry for Social Security and General

Scheme National Funds)

.

27. 

Complete the transfer to other funds of the management processes specific to certain rights and

benefits, by also transferring to the delegated funds the control, payment and accounting of related

transactions

(Ministry for Social Security and General Scheme National Funds).

28.

 

In order to increase synergies, link the social health insurance service to all the CPAMs

and the services for the pricing and prevention of accident at work or occupational disease

to the CPAM of the regional capital, which will make the CARSAT funds responsible only for

retirement

(Ministry for Social Security, CNAM and CNAV

);

29.

 

Following the example of the CPAM councils, draw up a restrictive list of responsibilities for

the boards of directors of the CAFs, CARSATs and CGSSs and, for all the councils, restrictive

lists of commissions

(Ministry for Social Security).

30. 

Define a compulsory basis for national and local inter-branch cooperation, covering in

particular support functions, productivity measurement and the deployment of shared tools for

customer relationship management to promote common pathways for insured persons and

beneficiaries

(Ministry for Social Security and General Scheme National Funds).

Chapter XI - Ensuring the extension of the URSSAF remit and

modernising the management of the collection of social

contributions

In 2019, the network of Unions for the Collection of Social Security Contributions and Family

Allowances (URSSAF, Union pour le recouvrement des cotisations de sécurité sociale et

d’allocations familiales) collected almost €360bn in social security contributions, i.e. around 75% of

the contributions allocated to the financing of legally compulsory social protection.

It is made up of a national public body, the Agence centrale des organismes de sécurité sociale

(Acoss), and 27 local bodies with legal personality: 22 URSSAFs in mainland France, 4 overseas

General Social Security Funds (CGSS, Caisse générale de sécurité sociale) and the Mayotte social

security fund.

An almost exclusive collector of social security contributions

Between 2018 and 2023, the URSSAF network must become responsible for the annual

collection of €110bn in additional contributions.

For the most part, in 2023, the contributions collected by the Agricultural Social Mutual Fund (MSA,

Mutualité sociale agricole) and the pension contributions of the regulated private sector professions,

i.e. only around 5% of social security contributions, will remain outside its remit.

Transferring the collection of supplementary pension contributions: a risky

operation

The transfer by 2022 of the collection of compulsory supplementary employee pension contributions

(General Association of Executive Retirement Institutions/Association for the Supplementary

Pension Scheme for Employees (Agirc-Arrco, Association générale des institutions de retraite des

cadres-Association pour le régime de retraite complémentaire des salariés)) is the most important

from a financial point of view (€69 billion in 2019). It is also the most risky.

In order to ensure the accuracy of employees' rights to supplementary pensions, Agirc-Arrco

recalculates for each employee the amounts of contributions owed by employers based on the

salary data declared per employee. On the other hand, the collection of contributions by the

URSSAFs is essentially based on the use of aggregated data declared by the employers for each

business establishment, and not on the use of data declared per employee.

The URSSAFs and Agirc-Arrco intend to get around this difficulty by setting up a dual organisation

between their two networks and computer exchanges. However, this system presents risks of

malfunctioning similar to the precedent of the Single Social Contact Point (ISU, Interlocuteur social

unique) between the ex-RSI (Social Schemes for the Self-Employed) and the URSSAFs.

Even if the transfer of collection is delayed, a unified organisation around the URSSAFs should be

prioritised, which means that their information system will enable them to collect contributions from

companies in an individualised manner for each employee. The calculation of contributions per

employee must be preserved.

Management to be improved

The extension of their field of operation must not divert the URSSAFs from the other worksites

necessary to improve their management.

The performance of the URSSAF network continues to be hindered by the social security

contributions

’

collection situation in the French overseas territories: with 1.8% of social security

contributions and levies, the overseas bodies accounted for 22% of the total receivables

inventory at the end of 2019 (all types of contributors combined) and 43% of the prescribed

receivables inventory at the end of 2019. In spite of clear progress, there has not yet been a

full return to the normal collection of contributions from tradesmen-businessmen after the major

malfunctions of the ISU.

Launched more than ten years ago, the project to overhaul the core business information

system has yet to be finished. Contrary to the initial schedule, the delivery of certain modules

will not take place until after 2022.

The territorial organisation of the URSSAF network has not yet taken full advantage of the

potential offered by its regionalisation between 2012 and 2014. The number of production sites

has been reduced only marginally, from 149 to 140 between 2014 and 2019; 20% of the sites

had less than 40 FTEs in 2018. This organisation does not allow for the most efficient use of

human resources and premises and makes it difficult for regional managers to manage

activities, despite remote communication tools.

Making better use of nominative social declarations

The URSSAFs are responsible for ensuring that contributors file the required declarations and

that they declare all of the contribution tax bases for which they are liable.

In order to improve the thoroughness of the amounts declared spontaneously by contributors,

the URSSAFs would benefit from improving the service they provide by simplifying and making

the declaration procedures more reliable. They could therefore redeploy resources to increase

documentary and on-the-spot checks aimed at detecting undeclared work.