Medical restraint under debate

The concept of medical restraint is necessary, but without guarantees regarding the use of savings, it risks creating a two-tiered healthcare system. This topic is now entering public debate as the 2027 budget for the Social Security system is to be examined by the National Assembly starting on October 20.

Current spending in healthcare

According to the Drees, less than three euros out of every hundred spent on health go to prevention. The rest treats illness once it has developed. No one decided on this division, recalls Jean-François Delfraissy, president of the National Ethics Advisory Committee (CCNE).

A system under pressure

The system remains one of the most protective in the world, but its model is becoming difficult to sustain. It is organized around care rather than good health. Restraint: a question before each act.

Defining medical restraint

The CCNE has placed medical restraint at the heart of the 2026 General Assembly on Bioethics. The term evokes deprivation, although it refers to a question posed before each act: is it useful, necessary, and does its benefit justify the constraints it imposes? This is the "just care."

Measurable consequences

The stakes are measurable. In its December 2025 report, the National Academy of Medicine describes care that has become a consumer good that can be abused. France prescribes about a quarter more antibiotics than the European average. Doctors surveyed estimate that one in four acts is not justified.

Impact on the elderly

Medications alone cause more than 200,000 hospitalizations per year. The elderly are first exposed to excess. Among the elderly, the immediate risk lies in excess rather than lack. Benzodiazepines, heavily prescribed in France, multiply falls after the age of 75, and a fall at 80 often signifies the end of home life.

The trap of transfer

The danger lies elsewhere, in the promise of redistribution. The argument is familiar: fewer unnecessary examinations to fund innovative treatments, which are increasingly costly. The reasoning holds on paper, but no mechanism guarantees this redirection.

Financial context

For a budget, one euro saved on an unnecessary examination and one euro saved on a refused treatment are identical: they contribute to the same deficit. The financial context weighs. The 2027 financing bill aims to reduce the Social Security deficit to 12.7 billion euros, with a limited increase in the Ondam to 2.0%.

Risk of inequality

Without guarantees, warns Jean-François Delfraissy, the most expensive treatments will first go to those who can pay: a healthcare system for those who pay, and another for the rest. A restraint that finances nothing becomes a restriction under another name.

Three causes to address

The first lever is pricing. A system paid per act produces acts, and no flat rate compensates for inaction. The Igas and IGF have shown that the technical flat rate for a scan or an MRI covers an average of 163% of actual costs, which fuels the financialization of imaging and biology.

Training and organization

The second is training. Medicine teaches how to prescribe, much less how not to prescribe, even though refusing a prescription requires examining and explaining. The third is organization. Medical time is scarce, and the follow-up of chronic diseases such as diabetes or hypertension can be entrusted to other professionals.

Prevention and long-term vision

Prevention requires a multi-year vision. An annual budget mainly finances what it sees: declared illness, hospitalization, and emergency care. Prevention costs this year and pays off in fifteen years, under a different mandate.

Shifting resources

The Academy of Medicine and Jean-François Delfraissy advocate for gradually shifting resources from curative care to prevention, without opposing the two. It remains to specify from whom resources are withdrawn and over how many years.

Need for a programming law

A programming law, on the model of those that exist for defense, would provide this visibility. Past 80 years, prevention becomes very concrete: replacing a bathtub with a shower is not prescribed; it is organized at home.

Existing legal safeguards

The law already sets safeguards. The February 2, 2016 law, known as Claeys-Leonetti, prohibits unreasonable obstinacy, that is, unnecessary or disproportionate acts. It requires a collective decision when the patient can no longer express their will.

Palliative care and effectiveness

The May 26, 2026 law guarantees access to palliative care: the right is open, but its effectiveness depends on resources. The citizen committee convened by the CCNE and the Economic, Social, and Environmental Council requests that the collective decision become the rule and that assistance never replaces the healthcare system.

A simple criterion

A simple criterion is added: before any heavy treatment, ask the patient what they expect, what they still hope for, and what they are willing to endure. This is what distinguishes the just care from abandonment.

A governance choice

For decision-makers, medical restraint is first a governance choice. It becomes a pretext for treating the elderly or vulnerable less well as soon as a word enters a budget before entering a practice.

Upcoming meetings

Two upcoming meetings approach, of unequal significance: the conclusions of the General Assembly, which no one is required to follow, and the Social Security budget, which everyone must apply.

The fundamental question

The healthcare system remains effective and solidarity-based. It is its model that is becoming difficult to sustain, and the fundamental question remains: at 90 years old, what is still worth being endured? Only the person concerned can answer this, provided that it is asked of them.