France's national health insurer, l'Assurance Maladie, is considering new limits on how physiotherapy sessions are reimbursed after spending on the treatment climbed to 5.3 billion euros in 2025. The proposal appears in a report the organisation sent to the ministry overseeing Social Security, covering the 2027 budget.
Physiotherapy spending has grown by an average of 4% a year over the past decade, the report says. L'Assurance Maladie is looking for several billion euros in savings across the social security budget, and physiotherapy is one of the areas it wants to act on.
Why spending has grown
Several factors explain the rise, starting with greater use of physiotherapy and more intensive treatment per patient. The number of physiotherapists working in France has also grown sharply, reaching 84,500 in 2025, 37% more than a decade earlier.
Caps, flat fees or declining rates
The report proposes gradually moving away from the current system, in which every session carried out is reimbursed. Several scenarios are on the table: setting a maximum number of reimbursable sessions depending on the condition being treated, reducing the rate paid as a course of rehabilitation continues, or introducing flat-rate packages for certain kinds of care.
At this stage, the report does not call for a blanket cut to reimbursements. But for patients undergoing long courses of rehabilitation, the question is far from minor. Once a cap is reached, reimbursement could be reduced or stopped, depending on which mechanism is adopted.
'Patients are increasingly chronic'
Physiotherapists accept that spending has risen but reject the idea that it reflects a shift in their own practices. Thomas Prat, vice-president for relations with l'Assurance Maladie at the Fédération Française des Masseurs Kinésithérapeutes Rééducateurs (FFMKR), the profession's main union, said physiotherapists are treating an increasingly chronic patient population, pointing to an ageing population as an obvious driver of the increase.
Prat also pointed to a shift of care from hospitals into the community. He said patients now leave hospital more quickly and earlier than before, which naturally means they need more follow-up care, and that physiotherapists are the ones meeting that need.
Physiotherapists dispute income claims
The profession also disputes the idea that rising spending has directly benefited physiotherapists' own earnings. According to figures cited by l'Assurance Maladie, income per physiotherapist rose by just 0.6% over ten years. Prat said that once inflation and the running costs of practices, which he estimated had risen by around 20%, are taken into account, physiotherapists have in fact seen a net loss of purchasing power.
Union warns against a 'purely accounting' approach
The FFMKR says it is willing to discuss which treatments are genuinely necessary, but only on condition that any reform does not translate into a new financial squeeze on physiotherapists or on vulnerable patients. Prat warned that if the approach were purely accounting-driven, it would be to the detriment of both patients and practitioners.
The idea of capping the number of sessions drew particular concern from the union. Prat said patients who need long courses of treatment are precisely those who are oldest, most frail or most dependent. The profession was more open to flat-rate packages, however, noting that for some neurological conditions, a short period of intensive rehabilitation can work better than care spread thinly across a year.
What happens next
It remains to be seen which proposals will be adopted for 2027. Prat said priority should be given to prevention, delivered either at home or in the workplace. He said every euro invested in prevention avoided far heavier healthcare costs later on, even if that saving does not show up immediately in Social Security's short-term accounts.
