Background: Identifying the most frequently treated and the costliest health conditions is essential for prioritizing actions to improve the resilience of health systems. Objectives: Healthcare Expenditures and Conditions Mapping describes the annual economic burden of 58 health conditions to prepare the French Social Security Funding Act and the Public Health Act. Design: Annual cross-sectional study (2015–2019) based on the French national health database. Subjects: National health insurance beneficiaries (97% of the French residents). Measures: All individual health care expenditures reimbursed by the national health insurance were attributed to 58 health conditions (treated diseases, chronic treatments, and episodes of care) identified by using algorithms based on available medical information (diagnosis coded during hospital stays, long-term diseases, and specific drugs). Results: In 2019, €167.0 billion were reimbursed to 66.3 million people (52% women, median age: 42 y). The most prevalent treated diseases were diabetes (6.0%), chronic respiratory diseases (5.5%), and coronary diseases (3.2%). Coronary diseases accounted for 4.6% of expenditures, neurotic and mood disorders 3.7%, psychotic disorders 2.8%, and breast cancer 2.1%. Between 2015 and 2019, the expenditures increased primarily for diabetes (+€906 million) and neurotic and mood disorders (+€861 million) due to the growing number of patients. “Active lung cancer” (+€797 million) represented the highest relative increase (+54%) due to expenditures for the expensive drugs and medical devices delivered at hospital. Conclusions: These results have provided policy-makers, evaluators, and public health specialists with key insights into identifying health priorities and a better understanding of trends in health care expenditures in France.

L’évolution récente du cumul emploi-retraite, l’instauration de la surcote et la baisse de la décote s’inscrivent dans la volonté affichée, depuis la réforme des retraites de 2003, de favoriser l’emploi des seniors et de leur permettre d’arbitrer plus librement entre départ à la retraite et poursuite d’activité. Les premiers résultats disponibles sur les retraités du régime général qui reprennent une activité salariée montrent un recours au cumul emploi-retraite encore limité, de l’ordre de 5 % des nouveaux retraités. Cette population se caractérise par des durées d’assurance élevées, une situation favorable en termes d’emploi en fin de carrière mais aussi parfois l’existence de certains aléas durant la vie active plus marqués que pour la moyenne des retraités, et une plus forte présence de personnes se déclarant non mariées. Inciter les retraités à reprendre une activité pose des questions sur le sens donné aujourd’hui à la retraite, mais aussi sur l’existence d’effets d’aubaine pour certains assurés et le coût de cette mesure pour les régimes de retraite.

Background Description of the prevalence of diseases and resources mobilized for the management of each disease is essential to identify public health priorities. We described the prevalences of 58 health conditions and all reimbursed healthcare expenditure by health condition in France between 2012 and 2017. Methods and Findings All national health insurance general scheme beneficiaries (87% of the French population) with at least one reimbursed healthcare expenditure were included from the French national health database. We identified health conditions (diseases, episodes of care, chronic treatments) by algorithms using ICD-10 codes for long-term diseases or hospitalisations, medications or medical procedures. We reported crude and age and sex-standardized annual prevalences between 2012 and 2017, and total and mean (per patient) reimbursed expenditure attributed to each condition without double counting, and according to the type of expenditure. In 2017, in a population of 57.6 million people (54% of women, median age: 40 years), the most prevalent diseases were diabetes (standardized prevalence: 5.8%), chronic respiratory diseases (5.5%) and chronic coronary heart disease (2.9%). Diseases concentrating the highest expenditures were active cancers (10% of total expenditure of 140.1 billion euros), mental illness (10%; neurotic and mood disorders: 4%; psychotic disorders: 3%), and chronic cardiovascular diseases (8%). Between 2012 and 2017, the most marked increase in total expenditure concerned liver and pancreatic diseases (+9.3%), related to the increased drug expenditure in 2014. Conversely, the increase in the number of patients (and the prevalence) explained the majority of the increase of total expenditures for cardiovascular disease, diabetes and mental illness. Conclusions These results showed a regular increase of the prevalence and expenditure of certain chronic diseases, probably related to ageing of the population, and increased expenditures related to major therapeutic innovations. The Diseases and Healthcare Expenditure Mapping therefore enlightens decision-makers in charge of public health and health accounts.