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Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: 0%; Total: 100%

*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

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

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“The French health system is universal in terms of population covered and provides a generous benefits basket combining a social health insurance system with a national health system approach.

“France promotes equity in access to healthcare through a number of regulatory tools and policies. All legal residents have access to statutory health insurance, which provides a broad benefits basket with rapid uptake of innovation, based on the principle of equal access to care depending on the needs of the population, not on their income. Coverage is also available to undocumented migrants under certain conditions. While the SHI requires cost-sharing for all services covered, some people are exempted from user charges (for example, people with chronic conditions, pregnant women, among others). As a whole, France presents the second lowest rate of user charges among the OECD countries.

“To reach this position, private complementary health insurance is a vital part of the social protection system. About 96% of the French population holds a CHI, mainly to cover the co-payments. The government subsidizes private CHI for wage earners and there is a public CHI scheme for the less well-off.

“As a result, France shows low rates of unmet care needs for financial reasons and high patient satisfaction. Nevertheless, social inequities in access remain particularly high when it comes to access to specialists and optical and dental care, which are less well covered by SHI and CHI. To ensure financial access, a recent reform has introduced a basic benefits basket with full coverage for optical devices, dental care and hearing aids (known as “100% Santé”).”

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.

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“Overall, healthcare accessibility is high in France, with universal health insurance coverage and a broad and unique benefits basket for all residents. Financial accessibility is supported by a state-funded insurance which avoids cost-sharing for the poorest part of the population and for those with high healthcare needs (see Section 3.3.1).

“Nevertheless, the existence of cost-sharing for most services creates the need to pay for a private complementary health insurance, which can constitute significant spending for low-income households. Recent reforms have pushed for increased regulation of CHI [Complementary Private Health Insurance] contracts so that they cover 100% of the cost of a range of services with regulated prices, including basic dentures, hearing aids and optical care, resulting in a better coverage of these services (see Section 7.3).”

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.

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“The SHI [Statutory Health Insurance] is composed of three categories of schemes, which cover the entire population. Individuals and their families are affiliated with a scheme based on employment status. Working people have no choice regarding the scheme in which they are enrolled and may not opt out of coverage except in certain cases (for example, expatriates and employees of international corporations or institutions). Thus, there is no competition among the schemes. Persons who are not working are automatically enrolled in the general scheme, which is the major scheme.

“The three categories of schemes and their beneficiaries in 2020 are approximately as follows:

“1. the general scheme (Caisse nationale d’assurance maladie, CNAM) covers everybody (around 88% of the population) except those eligible for other schemes (CNAM, 2021k);

“2. the agricultural scheme (Mutualité sociale agricole, MSA) coversfarmers and agricultural employees and their families (around 5%of the population); and

“3. the numerous “special schemes”, over 20 in number, built upon pre-SHI prepayment systems for defined categories of workers: local and national civil servants, miners, military personnel, employees of the national railway company, the clergy, sailors, the national bank, the gas and electricity company (they cover 7% of the population but technically manage claims and benefits for hardly 3%) (UNRS,2022) (see Section 3.3.1).

“These schemes are federated into a National Union of Health Insurance Funds (Union nationale des caisses d’assurance maladie, UNCAM) for the purpose of representing the funds in negotiations with healthcare providers.

“Each of the two major health insurance schemes is made up of a national health insurance fund and local structures corresponding to the degree of geographical distribution involved.”

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.

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“Private health insurance offered by mutual benefit associations (mutuelles de santé) has existed in France since the 19th century and covered two thirds of the population by 1939 (Chevreul et al., 2010). The 1945 law that established the social security system redefined the role of mutuelles as complementary to the statutory health insurance scheme; by the early 1960s, their coverage had declined to one third of the population. VHI [Voluntary Health Insurance] coverage began to grow again, however, and by 2010 VHI covered 90% of the population (Figure 11.1).

“VHI’s main role is complementary, covering most user charges (but not the so-called deductibles; see further on). VHI policies also offer enhanced coverage of things not well covered by the statutory scheme, such as dental and optical care, and supplementary coverage for private amenities, such as the cost of a single room up to a daily limit. With the saturation of the VHI market, some insurers now offer services not covered by the statutory scheme. However, VHI is generally not used to jump public sector waiting lists or to obtain access to elite providers.

“In 2000, the government introduced a system of free VHI covering user charges (couverture maladie universelle (CMU-C)) for the poorest households. By 2010, CMU-C covered nearly 6% of the population (Dourgnon, Guillaume & Rochereau, 2012).”

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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“France has more than 600 mostly private nonprofit and for-profit complementary insurers (similar to Medigap coverage in the US) that provide partial reimbursement for out-of-pocket expenses for the same benefit package covered under universal health insurance and for supplementary benefits, mostly dental and optician services. Employers are required to offer and finance half of the premium costs to provide a minimal level of complementary health insurance for their salaried employees. For those below a poverty income ceiling, a minimum package of complementary insurance benefits is available without premium charges; this covers all coinsurance payments for physicians who accept universal health insurance tariffs as payment in full. Unemployed people maintain their usual coverage, as there is no ‘job lock,’ and their complementary insurance is ensured for up to one year of unemployment.”

Source: Michael K. Gusmano, Miriam Laugesen, Victor G. Rodwin, and Lawrence D. Brown. Getting The Price Right: How Some Countries Control Spending In A Fee-For-Service System. Health Affairs 2020 39:11, 1867-1874.

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“The SHI [Social Health Insurance] system offers coverage to the whole population based on residence through various compulsory schemes. The main fund (Caisse Nationale d’Assurance Maladie des Travailleurs Salariés, CNAMTS) covers 92% of the population; the agricultural fund covers another 7%. Other small funds (specific to certain professional categories, such as the national railway company) cover the remaining 1%. There is also a fully state-funded scheme providing access to a specific benefits package (essential care) for undocumented migrants.

“Nearly all the population (95 %) has complementary health insurance, mainly to cover co-payments and to attain better coverage for medical goods and services poorly covered by the SHI, such as dental and optical care (see Section 5.2).”

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.

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“In 2015, the French parliament adopted a law that aimed to increase the universality of health coverage and the uniformity of protection across the sickness funds. One of the main achievements of this reform has been to ensure continuity of health coverage when people face a change in their professional or personal situation. For example, before its adoption, workers who changed jobs involving a change in sickness fund affiliation could face a coverage gap of several weeks.

“Another important measure from this legislation consisted of integrating under their own name adults previously affiliated as dependents, making them full beneficiaries in a sickness fund. This is progress in the spirit of universality, particularly for non-working spouses. By the end of 2019, around 3.2 million people had been granted autonomous affiliation.”

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.

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World 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 August 11, 2023 by Doug McVay, Editor.