The Court of Auditors is recommending a novel solution to the Elysée Palace to redress the accounts of the French Health Insurance. AI could thus support staff in several aspects of the organization's management – while the deficit is widening and funding is no longer guaranteed without radical changes, the authority warns.
The budgetary difficulties of the French social security system are far from new. The organization, now known to the French as “Assurance Maladie,” celebrated its 80th anniversary this year. But in 2025, the growth of its enormous debt in terra incognita – while the State's accounts are also marked with a lot of red – threatens like never before the sustainability of this monument in the lives of the French.
As a sign that the situation is really bad, the Court of Auditors is sounding the red alert. It is asking the government to urgently implement unprecedented remedies, in addition to a profound budgetary reform. And there is talk of supporting the management of Health Insurance with artificial intelligence. But to fully understand what is happening, a look back at the history of Social Security and its equally famous hole in the accounts is essential.
We knew from the start that Health Insurance would be in deficit
When it was created in 1945, the concept was innovative. Social Security was originally financed by all workers. They paid a contribution proportional to their income. In return, the worker and his family receive, as soon as necessary, all the medical assistance they need. A system based, above all, on solidarity. And which is being implemented in a France ravaged by the war years.
This may surprise you, but, from the start, everyone is actually aware that this enormous redistribution tool will force the Public Treasury (and therefore your taxes) to regularly balance the accounts, "whatever the cost", for 80 autumns. Of course, it wouldn't take more to, at the end of endless chants, completely empty the salivary glands of our politicians, in 2025.
But in 1945, we see it differently with a certain transpartisan concord: certainly, we know from the start that the system will lose money. But it is also a very powerful stimulus instrument. And, since it is financed primarily by the workers themselves, we say, compensating for the difference will probably never cost very much. Saying that the "probably" should have probably tipped them off is a bit easy, in retrospect.
The "hole" in the Social Security system has existed for much longer than you might think
The Social Security system was enthusiastically adopted by the French, while the State regularly compensated for the difference, all with decisions whose "transparency" resembled that of a frosted smoked window. Its role was nevertheless indispensable, and the Social Security system became an unshakeable asset, despite its rather acrobatic accounting.
But from 1967 onwards, in a France undergoing profound transformations, the accounts began to cause concern. Georges Pompidou, the president at the time, was choking on what he called a "significant financial hole, of 3 billion francs" (the equivalent of nearly 4 billion euros in 2025 after inflation). The expression "hole" stuck.
Like the deficit, moreover. In 1979, when the newly created Court of Auditors poked its nose into it, it was still equivalent to 4 billion euros today. The 1980s marked a financial shift. RMI, lower retirement age to 60, rising unemployment... the first left-wing government of the Fifth Republic healed social wounds that could no longer be ignored since the turning point of May 1968.
The first "record" deficit attributed to the left has since been largely atomized.
At the same time, many low-income insured people joined the general scheme. Cash inflows no longer offset healthcare costs. This resulted in a record in 1995. A record that has since been largely beaten, if not completely shattered – rest assured. The curve is therefore suffering, with a figure that sinks deeply below the x-axis – €10.3 billion lower.
The opposition beats the left, with a program centered around reducing the healthcare deficit. Several right-wing governments want to strengthen the financing of Social Security. With several new taxes of relative creativity. And then, the "miracle" happens: at the dawn of the year 2000, the curve allows itself a little dip on the surface. The "hole" has disappeared, we think.
Rest assured: when we talk about Social Security, the most costly unforeseen events are always there to dampen the slightest sign of hope. A huge bubble, that of the internet, bursts without warning in the accounting pool. And the curve sinks back into the depths in a tornado of gurgling.
Since then, nothing has changed. In 2025, the hole is still there... and it's at a depth of 22.1 billion euros that we have to go and find it – with all the diving gear. The Covid pandemic and its new “whatever it takes” have established the organization's debt at such a monstrous level that it frightens even accountants.
Artificial Intelligence promises to change the game for these reasons
For its part, the Court of Auditors is no longer worried about the future of the system. It is shouting the urgency to act very quickly through reforms. And, as we told you, also by introducing more technological innovation. The Court of Auditors thus urges the State, for example, to establish the systematic use of AI "in entering identity and address data, writing reports, sending letters, or filling out patient records.".
This will save time, and therefore hours worked. This may seem modest given a debt of more than 20 billion euros. In reality, it is undoubtedly above all "prescription analysis" by AI that can really change the game in saving the Health Insurance system. The Court explains that it is necessary to develop "predictive management of pharmaceutical and medical stocks."
All of this should prevent surpluses of medications and supplies being thrown away in large numbers when they reach their expiration date. This predictive management also makes it possible to dynamically adapt purchases to meet future needs as closely as possible. For example, buying the right quantity of flu vaccines. Better adapt purchases of medications that expire quickly. And probably a much longer list of opportunities to reduce costs.
Another important lever for getting back to balance: AI's ability to very quickly analyze the vast databases of the French Health Insurance. This will then be able to detect practically 100% of fraud and errors, and punish them – including overpayments in your favor that slip under the health organization's radar.
So you've been warned: artificial intelligence will be there to save the agency, which also means fewer errors and unpunished fraud. We advise you to get out your calculator if you suspect the slightest overpayment.
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