Will ’s (CSV) financial margin shrink any further after he reads the annual report of the health and maternity health insurance scheme? Because the report’s final line calls for caution: “The Inspectorate General of Social Security can only urge caution with regard to all actions that aim to bring about a structural change, however minor, in the organisation of health and maternity insurance, both in terms of the provision of benefits and in terms of revenue.”

The ratio of overall reserves to expenditure should fall further by the end of 2024, from 20.3% in 2023 to 18.2% in 2024 (the law requires a 10% margin). The reserve should stand at €834.6m, but this is subject to certain conditions.

Says the report: “With regard to the sensitivity of the projected level of the reserve at the end of 2024 to a hostile geopolitical context, the IGSS wishes to emphasise the risk of a slowdown in employment growth in 2023 and 2024 compared with the current projections used in the scenario adopted… Consequently, in the event of a 0.5 percentage point slowdown in the labour market compared with the base scenario, the health and maternity insurance reserve would rise to a predictable 17.2% in 2024, well above the legal threshold of 10%.”

The health and maternity insurance scheme will end 2023 in the black, with a positive balance of €24.9m: it collected €4.284bn and spent €4.259bn--however, this was actually due to a 9.3% increase in revenue helped significantly by the state paying covid debts from 2020, 2021 and 2022 (totalling €37.5m).

The report also says: “Alongside the analysis of changes in revenue and expenditure, a number of relevant issues are also raised, such as the impact of the law on the shift to ambulatory care, the funding of incentives for doctors to digitalise, the application in 2024 of a catch-up factor linked to certain key-letter values due to the late application of the revaluation of key-letters for doctors, dentists and medical analysis and clinical biology laboratories. In addition, hospital reserves and the accounting of annual premiums as part of the quality programme are also being addressed.”

According to IGSS estimates, health and maternity insurance will cover 955,000 people this year and 968,000 next year, with 550,000 (2023) and then 560,000 (2024) insured people paying premiums, and 132,000 (2023) and then 136,000 (2024) pensioners paying healthcare premiums.

This article in Paperjam. It has been translated and edited for Delano.