France's national health insurer, l'Assurance Maladie, is examining ways to cut the cost of physiotherapy care, including limiting the number of sessions allowed for certain conditions and moving to a new payment system in which physiotherapists would be paid flat fees rather than per session. The proposals have split readers of La Dépêche du Midi, who responded to the newspaper's call for testimonies.
Social Security reimbursed 5.3 billion euros of physiotherapy care in 2025, a figure that has risen by 4% a year over the past decade, according to the newspaper.
Patients fear losing access to care
Helene, who lives in Toulouse, has seen her physiotherapist twice a week for more than ten years as part of treatment for a long-term illness. She said that if reimbursement fell, she would no longer be able to look after herself properly on her small pension.
Laurence, in Aiguillon in the Lot-et-Garonne department, is currently unemployed. She said it would be impossible for her to pay for sessions if only half were reimbursed.
For several patients with chronic conditions or recovering from surgery, physiotherapy is described not as a comfort but as an essential part of their treatment. Veronique, who lives in Morbihan, alternates two sessions a week between physiotherapy and hydrotherapy after undergoing two total knee replacement operations. She said she does not go for pleasure but out of necessity.
Some readers said they feared indirect consequences of any reduction in care. Celine, whose name has been changed, said a rise in the amount she would have to pay herself could stop her from getting treatment or even from continuing to work. Lou, from Agen in Lot-et-Garonne, said cutting sessions would simply move the problem elsewhere, arguing that prescribed physiotherapy often avoids surgical operations that would be just as costly.
Others call for tighter oversight
Not every testimony rejected the idea of better regulating care. Several readers argued that some sessions continue even after they are no longer necessary. Gisele, who had knee surgery, said she thought too many sessions serve no purpose. She described practices where several patients carry out their exercises at the same time, and said exercises such as cycling could be done at home.
For some readers, the real problem is not the number of sessions but what happens during them. Laurent, in Gaillac in the Tarn department, said physiotherapists who take on five or six patients at once are chasing volume rather than quality. Margo shared that view, suggesting that low fees and hourly rates push some professionals to treat several patients simultaneously. Margo, a competitive handball player from Toulouse, said she would accept a small out-of-pocket contribution, provided any limit on sessions was not too rigid. She said any limit should take account of the condition, the severity of the injury and how each patient's recovery progresses.
Calls for a longer-term view
Whether they support or oppose changes to reimbursement, many readers argued that an ageing population and a rise in respiratory illness should push the government to plan ahead for access to care in the coming decades. Rose, in Lyon, said the worsening climate and increasing pollution were already harming the health of people affected by environmental damage, while the state preferred to break the thermometers rather than address the cause.
