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.
“Given the importance of co-payments left to patients by the SHI [Statutory Health Insurance], 96% of the French population held CHI [Complementary Private Health Insurance] in 2019 (Pierre & Rochereau, 2022). Therefore, in 2019 France had the second lowest share of OOP spending in total health expenditure (around 9%) amongst OECD countries (after South Africa at 8%) (OECD, 2021b). On average, OOP [Out-Of-Pocket] costs accounted for 2% of final household expenses in 2019, compared to 3% among all OECD countries (OECD, 2021a). This OOP spending corresponds to the cost of care directly paid by households without counting the premiums paid for private CHI. It is estimated that in 2017 private payments including these premiums accounted for 4% of household budgets but could reach 8% for the lowest income groups (Fouquet & Pollak, 2022).”
Source: Or Z, Gandré C, Seppänen AV, Hernández-Quevedo C, Webb E, Michel M, Chevreul K. France: Health system review. Health Systems in Transition, 2023; 25(3): i–241.
“Overall, the share of direct OOP costs in current health expenditure has been stable and decreased slightly over the past decade, from 10% in 2010 to 9% in 2019 (OECD, 2021b). The reduction in OOP costs related to hospital care appears to be partly driven by the ageing of the population, leading to an increase in patients covered by the ALD scheme for chronic diseases reducing cost-sharing. In the ambulatory sector the caps applied to extra-billing in recent years (see Section 3.7.2) and higher reimbursement rates applied to certain drugs, including hepatitis C treatments and nicotine substitutes, have also contributed to reducing OOP payments (DREES, 2020a). In 2020 the Covid-19 pandemic and related restrictive measures led to a significant reduction in the use of all types of care, and, in particular, a lower use of hospital services for non-urgent conditions, which resulted in a drop in OOP payments as a proportion of all health consumption by 6 percentage points between 2019 and 2020 (DREES, 2020a).
“In 2020 the majority of OOP spending was on long-term care (43%), followed by pharmaceuticals and therapeutic devices (26%), outpatient care (26%) and inpatient care (5%) (OECD, 2021a).”
Source: Or Z, Gandré C, Seppänen AV, Hernández-Quevedo C, Webb E, Michel M, Chevreul K. France: Health system review. Health Systems in Transition, 2023; 25(3): i–241.
“User charges are asked for most healthcare goods and services in France. Primarily, patients are asked to pay a proportion of the tariffs (Ticket modérateur) or the full price to be reimbursed later by the SHI (Table 3.4).France 65Cost-sharing arrangements, initially intended to reduce inappropriate demand for care, are also used increasingly to encourage patients to follow standard care pathways (see Section 5.2). However, given the high proportion of the population with CHI, which sometimes reimburses OOP payments as a third-party payer, the impact of cost-sharing on patients’ behaviour appears to be limited. Therefore, over time different types of flat deductibles have been introduced to encourage patients to consider the costs of treatments and to contain demand for targeted services (Table 3.4).
“Flat rates, or deductibles (Participation forfaitaire), apply to outpatient consultations, pharmaceutical products, medical transportation, and consultations and care from allied health professionals. Overnight hospitalizations are subject to a daily catering fee (Forfait journalier); this does not apply to hospitalizations at home nor to day hospitalizations. In 2020 this fee amounted to €20 per day for acute and post-acute rehabilitation care and €15 per day for psychiatric hospitalizations (Adjerad & Courtejoie, 2021b). The hospital fees are regularly reimbursed by CHI, but the deductibles for outpatient consultations and prescriptions are, in principle, not reimbursable by the CHI.”
Source: Or Z, Gandré C, Seppänen AV, Hernández-Quevedo C, Webb E, Michel M, Chevreul K. France: Health system review. Health Systems in Transition, 2023; 25(3): i–241.
“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.
“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.
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Page last updated August 12, 2023 by Doug McVay, Editor.
