We, kidney patients, ask François Bayrou to please stop picking our pockets.
The government has decided: to fill the deficits, it will be necessary to make, among other things, €5 billion in savings on health care. And, once again, the sickest and most vulnerable will be called upon to contribute.
Doubling of deductibles and flat rates, questioning of the long-term illness (ALD) system, freezing of social benefits... The government's choice is not aimed at providing better care, nor at strengthening prevention or improving the efficiency of the health system, but at transferring an increasing part of the expenses onto the insured, in particular those whose survival depends on heavy and costly treatments.
Thus, among the 13 million people with long-term illnesses in France, more than 100,000 are on dialysis or have had a kidney transplant. All of them are reaching the annual ceilings for deductibles and flat rates, which the government plans to double (from 100 to 200 euros).
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Because their kidneys no longer function, the 55,000 people on chronic dialysis owe their survival to three long sessions of four to five hours each week, during which their blood is filtered by a machine. Any interruption results in death within a few days.
Dialysis is neither a luxury nor a fad for patients; it is an extremely restrictive vital necessity that requires significant medical, paramedical, and transport resources. With 156 dialysis sessions performed per year and an average annual cost of €63,000, it is the most expensive treatment per patient for health insurance.
Dialysis is one of the treatments that most impairs quality of life . Life expectancy on dialysis is lower than that of most cancers.
In addition to the burden of treatment and the many complications associated with it, people on dialysis face job loss, poverty and precariousness due to their health condition .
Less than 18% of those of working age have a job [ PDF ], most often part-time, compared to 82% of the general population. Two-thirds have less than 1,100 euros per month to live on.
Despite the ALD system, they pay an average of at least €840 each year in out-of-pocket expenses , according to the General Inspectorate of Social Affairs. Those who can afford it pay out of pocket for essential, unreimbursed care, including excess fees from which they are not exempt.
How will charging these people more reduce costs? What exactly are they being offered without seriously endangering their health?
What accountability are we talking about when we say nothing about the prescriptions, bad practices, inadequate or abusive care, which weigh heavily on public spending?
Because the flood of suffering and the billions of euros from dialysis also make people happy.
Since 2015, the Court of Auditors has denounced its excessive profitability and the abuses it causes. Most recently, health insurance revealed that between 2018 and 2022, the average turnover of dialysis facilities jumped by 21%, with exceptional profitability rates exceeding 15%.
Each dialysis patient thus brings in an annual net profit of 6,000 to 8,000 euros, from health insurance funds and therefore from national solidarity, paid to shareholders or reinvested in real estate.
These annuities are subject to optimizations aimed at maximizing them, always to the detriment of patients and the quality of care: abusive acts ( as in the recent Nancy affair ) or fictitious, dialysis carried out too early or unnecessarily, insufficient prevention strategies, poor quality dialysis, lack of access to the transplant waiting list, to supportive care, elimination of meals and snacks, etc.
Abuses and poor practices in nephrology are not exceptional . Their frequency is such that they are even reflected in national data. For example, 32% of patients under 60 without any comorbidities are still not even registered on the transplant waiting list after one year of dialysis, whereas they should be one year before the start of dialysis, according to the recommendations of the High Authority of Health. The medical and human losses for the victims of these poor medical practices are considerable, as are the associated costs for the community. This must be stopped.
In 2024, the health insurance system proposed reducing the need for dialysis through better prevention, earlier screening and more transplants, promising savings of €130 million over five years.
But the costs associated with chronic kidney disease (CKD) go far beyond dialysis. The human and financial costs of the serious cardiovascular complications affecting the approximately 5.9 million people affected by CKD in France, most of whom are undetected and therefore untreated, are staggering. They could, and should, be avoided, since effective treatments now make it possible to slow or halt the progression of chronic kidney disease and avoid dialysis. The potential savings on healthcare costs amount to billions of euros over ten years, but require the implementation of an ambitious kidney health strategy, including screening, prevention, and the development of transplants.
Curiously, none of the government announcements mention it.
However, there are major issues here for the sick and for the sustainability of our health system, which is seriously threatened, as is the principle of solidarity which presided over the creation of our social security.
It is so much easier to attack the most vulnerable, rather than considering the structural reforms essential to its preservation.
We, kidney patients, are waiting for the implementation of these strong measures and we ask Mr. Bayrou to kindly stop picking our pockets.
Christian Baudelot, Francis Berdah, Yvanie Caillé, Laurent Di Méglio, Céline Hacker, Pascal Hermel, Jean-Pierre Lacroix, Enguerran Le Gueut, Mauricette Salque, Sylvie Mercier, Nathalie Mesny
Renaloo Administrators and Board Members
This article is an op-ed, written by an author outside the newspaper and whose point of view does not reflect the editorial staff's views.
