The State has deepened the deficit of public hospitals between 2020 and 2024 by under-compensating for salary measures in the establishments, with a shortfall estimated at 1.7 billion euros at "end of 2024", according to a report by the General Inspectorate of Social Affairs (IGAS) published on Wednesday.
These additional unfunded expenses can "explain a significant portion of the worsening deficits" of healthcare facilities, according to the IGAS (General Inspectorate of Social Affairs). The Inspectorate notes that the deficit of public hospitals was estimated at €3.1 billion in 2024.
The largest part of the shortfall, namely 1.1 billion euros, comes from "the recurring under-financing" of the automatic evolution of the payroll due to promotions and the aging of non-medical staff (the "seniority-based salary increase" or GVT), explains the Igas.
Next comes the underestimation of the salary measures decided after Covid, including the Ségur de la santé, to prevent the flight of healthcare workers from public hospitals, amounting to 457 million euros.
Finally, the lack of revaluation of the fixed remuneration of interns, "despite successive increases in their remuneration and the increase in their numbers", has increased the uncompensated expenses of hospitals by 137 million euros, indicates the Igas.
On the other hand, regarding inflation, which has been repeatedly denounced by hospital managers, the report does not seem to detect any under-compensation, noting that "the credits integrated into the base should balance the expenses by 2025 at the latest".
The French Hospital Federation, which represents French public hospitals, welcomed the "validation" by the IGAS of its arguments regarding the underfunding of salary measures.
However, she regrets that the IGAS remains silent on the underfunding of inflation. "In 2024, the FHF estimated the need for inflation compensation at 1.3 billion euros for public institutions alone," she recalled.
In the evening, the Ministry of Health estimated that the government "had already taken its responsibilities" in the 2026 Social Security budget, to make up for the under-compensation of wage measures.
The 850 million euros added to the hospital budget during the parliamentary debate "make it possible to settle this under-compensation and open a new virtuous cycle," the minister's office indicated.
"A +Hospital Efficiency 2026-2029 plan will be prepared," including "a renewed territorial governance," the same source indicated.
According to the minister's office, the plan will be based on another Igas report, also published on Wednesday, which proposes an organizational shock to the hospital system.
In particular, it recommends the creation of public hospital groups within a territory, bringing together several establishments in a single structure.
This will notably involve being able to "pool support functions and medical-technical services", according to the report.
The report also suggests "accelerating the development of outpatient care and home hospitalization" and "the territorial reorganization of the healthcare supply to ensure a better gradation".
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