Seven hundred and eighty-seven million euros. That was the size of Gesy's reserve fund at the end of 2025. An amount sufficient to cover almost five months of the system's expenditure. Excellent news, if the success of a healthcare system is measured by its financial strength.
The problem is that Gesy was not created to save money. It was created to treat patients. And somewhere in the effort to safeguard the first objective, there is a risk that we are forgetting the second.
The patient often comes second
In recent years, we have heard countless warnings about abuse, excessive spending and the need to protect the sustainability of Gesy.
Far less attention has been paid to patients who are forced to pay out of their own pockets for services the system is supposedly designed to cover. Not because they chose private healthcare, but because someone decided that the treatment they are entitled to should stop at a specific limit, that the number of visits must not exceed a predetermined threshold, or that their condition does not meet the reimbursement criteria.
Take physiotherapy as an example.
A patient may genuinely require more sessions than those allocated for their condition. Gesy has procedures through which additional treatments can be approved. That does not mean, however, that every genuine need is automatically covered. When extra care is not approved, the patient is left with two choices: pay for treatment or go without it.
The difference between control and restriction
Of course rules are necessary.
Of course every request cannot automatically become an expense borne by the system.
There is, however, a significant difference between limiting abuse and limiting necessary care. We should not pretend that every numerical cap imposed by the system automatically reflects the real needs of every patient.
Strong reserves raise new questions
The greatest contradiction is that these debates are taking place while Gesy itself holds a particularly strong reserve fund and while actuarial studies confirm its sustainability until 2033.
Perhaps it is time to reassess priorities.
No one is suggesting that the reserves should be exhausted or that spending should proceed without control. What is required is the sensible use of part of the available resources to deliver more services, better services and more meaningful care.
Restrictions that fail to reflect patients' actual needs should be reviewed. Benefits should be strengthened. Financial sustainability should not be used as an argument that automatically shuts down every discussion about expanding care.
Who ultimately benefits?
Who benefits from a financially healthy Gesy if patients still need their own wallets to secure necessary treatment?
And what exactly are we celebrating when the reserves grow while needs remain unmet?
Gesy is not a bank, and our contributions are not deposits waiting to earn interest. They are payments we make so that we can access healthcare when we need it.
Financial sustainability is essential. But it is not an end in itself.
At the end of the day, there is little value in healthy accounts if maintaining them means shifting the burden onto patients.
