PRESS RELEASE

7 March 2024

Flash audit

CNAM AID FOR OCCUPATIONAL

RISK PREVENTION:

UNPROVEN EFFECTIVENESS

When it comes to accidents in the workplace, prevention must take precedence over compensation.

However, prevention measures currently account for only 2

% of the total budget for the

occupational accidents and diseases

component of the health insurance system. In companies with

more than 150 employees, the incentive to improve prevention is provided by a level of contribution

based on the severity and frequency of workplace accidents and occupational illnesses in the

company. In smaller companies, there is a flat rate linked to the number of accidents in their business

sector. To encourage small businesses to prevent occupational risks, the CNAM can provide financial

aid.

This flash audit, carried out in the context of a significant increase in resources, made possible by the

creation in 2023 of a fund for investment in the prevention of occupational exhaustion, recommends

a review of the aid schemes, which are currently too poorly targeted and insufficiently evaluated.

Two types of aid with very different approaches

Two schemes designed to promote the prevention of occupational risks exist side by side: on

the one hand, customised prevention contracts entered into between companies with fewer

than 200 employees and the CARSATs (regional retirement and occupational health funds) and,

on the other, subsidies aimed at very small enterprises (VSE) with fewer than 50 employees and

distributed on a one-stop basis. Between 2019 and 2022, this aid totalled €384 million, three

quarters of which was in the form of subsidies. Their mechanisms serve different purposes.

The aim of prevention contracts is to implement an overall occupational risk prevention plan at

company level. They must be part of a national agreement on objectives defined for each

business sector by a joint body. Their development depends on the capacity for action of the

professional federations and the human resources available in the CARSATs. Their

implementation is systematically monitored on site by health insurance officials. The frequency

of workplace accidents in companies that have entered into a prevention contract is not

significantly different from that in companies as a whole.

Subsidies for VSEs, allocated on request within the limits of an annual national budget, are

intended to finance equipment or training initiatives. The number and purpose of these

subsidies vary from year to year, and the conditions under which they are awarded are defined

at a late stage. Although their effect on reducing occupational risks has not been demonstrated,

their budget is steadily increasing.

Pending better targeting of this aid to sectors with a high

accident rate and the introduction of a reliable method for assessing its effectiveness, the Court

recommends suspending these measures and replacing them with awareness-raising

campaigns aimed at small businesses in the sectors most affected by occupational accidents

and diseases.

Lack of oversight and tools

The effects of aid on the prevention of occupational risks are insufficiently evaluated.

Furthermore, the distribution of subsidies between the various business sectors only very

partially takes account of their accident rates. In reality, the capacity to mobilise the parties

involved, particularly companies and professional federations, has a greater influence on the

allocation of subsidies. An evaluation of the impact of these subsidies, based on data from the

CNAM's occupational risks department, is essential in deciding whether to maintain, withdraw

or promote each scheme. It would allow targets to be adjusted according to the size of the

company or the business sector.

Internal control deficiencies

For a long time left to the initiative of the

CARSATs

, checks on the conditions for awarding

prevention contracts and VSE subsidies were of varying quality. The CNAM recently initiated a

coordinated approach to internal control and the fight against fraud. The recent changes made

to the conditions for payment of subsidies, such as the requirement to produce a bank

statement to certify that expenditure has actually been incurred, need to be supplemented. For

example, the obligation to indicate the names of suppliers or service providers, who are the

ultimate beneficiaries of financial aid, in the computer application used to manage prevention

contracts, would make it easier to detect any de facto monopolies or other anomalies. Finally,

the obligation to carry out on-site inspections, as was the case until 2019, should be reinstated.

Read the report

PRESS CONTACTS:

Julie Poissier

◼

Head of Media & Social Networks

◼

T

+33 (0)6 87 36 52 21

◼

julie.poissier@ccomptes.fr

Sarah Gay

◼

Press Relations Officer

◼

T

+33 (0)6 50 86 91 83

◼

sarah.gay@ccomptes.fr

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