French spas oppose health insurance reform

French thermal spas are opposing a proposed change in health insurance coverage that would shift the reimbursement of spa treatments from the national health system to private complementary insurance. The reform aims to save 200 million euros but has raised concerns that some patients may no longer have coverage, as private insurers are not required to reimburse treatments.

Current reimbursement structure

Currently, patients cover their own transport, accommodation, and meals but receive 65% reimbursement from the national health insurance for the actual treatments, which cost around 700 euros. The proposed change could create uncertainty about reimbursement, potentially affecting decisions to book treatments and impacting the activity of spa towns.

Concerns over equal access

The move is seen as a risk to equal access to care, according to two parliamentarians and Julien Dubois, mayor of Dax and president of the National Association of Mayors of Thermal Towns. This association represents 80 cities and highlights the potential negative impact on smaller spa towns, many of which have fewer than 5,000 inhabitants.

Economic impact criticized

The presidents of the Regions of France have criticized the move as a "strategic error" on medical, budgetary, and social levels. They note that thermal treatments contribute "hundreds of millions of euros and tens of thousands of jobs" directly or indirectly, serving as a major economic lever in local areas.

Tourism sector reacts

Christelle Chassagne, president of ADN Tourism, which represents tourism offices, called the decision "unilateral, rushed, and totally unfounded." She argues that thermalism brings significant benefits in non-outsourced jobs, tourism activity, and regional vitality while costing little to the national solidarity.

Calls for investment

The Regional Court of Accounts for the Grand Est has called for investment to enhance the competitiveness and attractiveness of spa towns. Meanwhile, the Plombières-les-Bains spa in the Vosges had to close in late 2024 after its judicial liquidation, with local officials noting the current state of thermal activity is nonexistent due to aging infrastructure.

Usage statistics

In 2025, nearly 470,000 patients underwent an 18-day conventional treatment on a medical prescription, according to the National Council of Thermal Establishments (CNETh), which represents all 103 structures in France. Franck Leroy, president of the Grand Est Region, warns that the government’s focus on "immediate accounting economy" could lead to increased use of medications, consultations, or hospitalizations.

Medical evaluation ongoing

The High Authority for Health (HAS), which was requested by the government last year, has begun evaluating the therapeutic contribution of spa treatments. It will provide an initial update by the end of the year to clarify its methodology and the projected timeline for this work, which is complicated by the significant differences between spa towns.

Need for clarity before decisions

Paul-François Houvion, general director of the Balaruc-les-Bains Thermal Establishment, says it is essential to complete this work before questioning the funding of treatments. Julien Dubois emphasized that it would be "absurd to decide" on a potential removal of reimbursement "before obtaining" the HAS conclusions.