Two hundred ten million euros spent, 158 thousand records opened, and more than half of them showing no usable data at all. That is the assessment the Court of Audit presented of the personal medical file, the predecessor of today’s Mon espace santé, in its July 2012 report and later integrated into the public annual report of February 2013. Eight years after the vote of the law intended to transform patient follow-up, the bill looked less like a digital success story and more like an administrative fiasco.
Key takeaways
- 210 million euros spent on a project that produced only 158,000 records, most of them nearly empty
- At the observed creation pace, it would have taken about 150 years to cover the entire French population
- A radical strategic shift turned the fiasco into a success: learn how
The figure that sparked the scandal: 210 million euros for 158,000 records
Everything began in 2004. Philippe Douste‑Blazy, then health minister, presented the personal medical file as the centerpiece of his reform of health insurance, accompanied by a quantified promise: 3.5 billion euros in annual savings through the elimination of redundant exams and duplicate prescriptions. Seven years later, by mid-June 2012, the tally stood at a meager 158,000 records created, out of the 66 million French people covered by the social security system.
The Court of Audit’s report, commissioned by the National Assembly’s Finance Committee, cuts straight to the point. The first part estimates the total cost of the DMP at no less than 210 million euros between the 2004 law creating it and the end of 2011. A floor figure, the financial magistrates note, given how deficient the project’s budget tracking was. By including the computerized patient files from hospitals that were supposed to interface with the DMP, the real bill would probably exceed half a billion euros, though a precise figure could not be provided due to unreliable accounting.
The pace of creation, meanwhile, was enough to frustrate observers. At roughly a thousand openings per day, it would have taken nearly 150 years to cover the entire French population. And among the 158,000 records that existed, an overwhelming majority contained almost no usable medical data—mere administrative shells without any summaries, medical analyses, or prescriptions.
A disjointed governance, software that does not talk to one another
How could a project with such a budget yield so little? The Court of Auditors points to a stack of dysfunctions rather than a single cause. Governance was dispersed among ASIP Santé (the agency responsible for technical deployment), the Health Insurance, and various data hosts, without a single leader capable of arbitrating or delivering clear accountability for the expenditures incurred. The magistrates denounce a “serious lack of financial oversight,” an “absence of analysis of the costs induced by its deployment,” and a genuine “governance failure.”
On the ground, technical incompatibility further undermined the adoption of the system. The professional software used in medical offices simply was not interoperable with the national platform, forcing practitioners to juggle multiple tools or to abandon feeding the record altogether. No regulatory obligation existed for doctors to upload documents to the DMP of their patients: the system relied on the goodwill of health professionals in a environment where every minute of a consultation counts.
Another structural flaw highlighted by the financial jurisdiction: from the outset, there was no realistic deployment timeline and no clearly defined cost ceiling. The project advanced through successive experiments, in four then five pilot regions, without the State ever setting precise milestones or a budget cap. As a result, expenditures accumulated without any intermediate objective allowing measurement of whether public money produced a proportional result.
From the revival under CNAM to Mon espace santé
Faced with this damning assessment, the government changed its approach. Marisol Touraine revived the file in 2013, and a management transfer, effective January 1, 2017, handed the entire system to the Caisse nationale de l’assurance maladie (CNAM). The idea was to bring the tool closer to the field by integrating it into the digital services already used daily by private-sector health professionals, rather than keeping it as an isolated technical platform managed by a third‑party agency.
This scaling change eventually paid off, at least in volume. The July 24, 2019 law renamed the system as the “espace numérique de santé,” commercially known since 2022 as Mon espace santé, with a decisive shift: automatic account creation unless the insured explicitly objects. By May 31, 2022, 11.2 million registrations on Mon espace santé followed the broad rollout in early 2022 and the start of automatic account creation on May 9. The rejection rate remained marginal, around 1.5%.
The trend continued. Since its creation in 2022, Mon Espace Santé has 24 million activated profiles, a figure that has risen sharply compared with the 15 million recorded at the end of 2024. CNAM now targets 40 million activated profiles by 2027, a goal backed by the Ségur numérique program, which funds software upgrades for health professionals, a sine qua non condition to prevent a repetition of the past issues with technical incompatibility.
One major caveat remains, as the Court’s more recent reports remind: opening an account is not the same as using it. A substantial portion of activated profiles still lacks significant real medical documents, and the financial jurisdiction continues to point out in its latest work a lack of shared objectives with patients and health professionals that undermines trust in these digital tools intended to improve daily medical monitoring.
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Sources: assurance-maladie.ameli.fr | oeil.europarl.europa.eu | senat.fr
