Annual household out-of-pocket payment in current USD per capita (2020): $426

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Dec. 3, 2022.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.0%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

Current Health Expenditure As Percentage Of Gross Domestic Product (2019): 11.06%

Source: Global Health Observatory. Current health expenditure (CHE) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed July 26, 2022.

Current Health Expenditure Per Capita (USD) (2019): $4,492

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed July 26, 2022.

Out-Of-Pocket Expenditure As Percentage Of Current Health Expenditure (2019): 9.26%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed July 26, 2022.

“Patients have access to public and private hospitals. Hospital treatment requires 20% coinsurance from patients. Coinsurance is not needed for costly surgeries. Patients also pay a lump sum per day in hospital for food. Outpatient care involves three types of user charges: coinsurance, extra-billing and deductibles. Coinsurance rates are 30% for physician and dentist care and 40% for ancillary services and laboratory tests. For most medicines, coinsurance amounts to either 70 or 35%, but ranges from 0% for non-substitutable or expensive medicines, to 85% for so-called convenience medicines. Some outpatient specialists use extra-billing.

“New user charges were introduced in 2005 and extended in 2008. These flat-rate user charges (see Chevreul et al., 2010:63) are referred to as deductibles and are generally applied to all outpatient care: €1 for physician services and laboratory procedures (limited to €50 per year); €0.50 per prescription drug package or ancillary service; and €2 per medical transport (limited to €50 per year). Patients also pay €18 for treatments for which the statutory scheme tariff is over a certain amount (€120). These deductibles are intended to lower use.”

Source: Karine Chevreul, Karen Berg Brigham and Marc Perronnin. “France.” Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

“France reports the lowest share of out-of-pocket (OOP) payments for health among all EU countries (9.3 % compared to a 15.4 % EU average; Figure 13) because public and private health insurance schemes cover most health spending. This is particularly the case under the scheme for people with chronic conditions, which covers all health-related costs linked to these conditions.”

Source: OECD/European Observatory on Health Systems and Policies (2021), France: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“Even after complementary insurance, out-of-pocket (OOP; reste à charge) payments from patients themselves account for 7.5% of total health expenditure. This raises issues of equity in access and financing, although this figure remains well below the EU average for OOP payments of 16.1% of total health expenditure.”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.

“People mainly buy VHI [Voluntary Health Insurance] for protection against widespread user charges for publicly financed health services. Since the early 1990s, over 90% of hospital expenditure has been financed publicly. However, public financing of outpatient care fell from 77% in 1980 to 63% in 2010 (Fenina, Le Garrec & Koubi, 2011). Between 1980 and 2008, the annual OOP payment per person grew from €217 to €547 in constant prices (Perronnin, Pierre & Rochereau, 2011). With the shifting of outpatient costs from the statutory scheme to households, VHI’s role in financing and ensuring access to care has grown.”

Source: Karine Chevreul, Karen Berg Brigham and Marc Perronnin. “France.” Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

“Just over three-quarters of total health care expenditure is publicly funded (77%; just above the EU average of 76%), principally through SHI [Statutory Health Insurance]. The proportion of costs covered by SHI varies across goods and services: from 15% for drugs with low medical benefit (service medical rendu; SMR) to 80% for inpatient care. However, there are several conditions for which patients are exempted from paying a part of the costs, such as chronic conditions or pregnancy after the fifth month. Additional co-payments that are not allowed to be covered by voluntary health insurance (VHI; assurance complémentaire) have been created with the aim of reducing demand and thus SHI expenditure.

“SHI resources mainly come from income-based contributions from employers and employees (including retirees). Since 1998, as a result of attempts to broaden the social security system’s financial base, employees’ payroll contributions have been almost fully replaced by a dedicated tax called the “general social contribution” (contribution sociale généralisée; CSG) based on total income rather than on only earned income, as was previously the case. Additional revenue comes from specific taxes such as taxes on potentially harmful consumption (tobacco, alcohol) and taxes on pharmaceutical companies.

“VHI provides complementary insurance, such as for co-payments and better coverage for medical goods and services that are poorly covered by SHI. It finances 13.8% of total health expenditure and covers more than 90% of the population. Over recent decades, VHI has gained a significant role in ensuring equity in access and financing health care. Since 2000, publicly financed complementary universal health coverage (couverture maladie universelle complémentaire; CMU-C) has been offered to those on lower incomes; it covers 7% of the population.

“Even after complementary insurance, out-of-pocket (OOP; reste à charge) payments from patients themselves account for 7.5% of total health expenditure. This raises issues of equity in access and financing, although this figure remains well below the EU average for OOP payments of 16.1% of total health expenditure.”

Source: Chevreul K, Berg Brigham K, Durand-Zaleski I, Hernández-Quevedo C. France: Health system review. Health Systems in Transition, 2015; 17(3): 1–218.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Dec. 3, 2022 by Doug McVay, Editor.