France: Health System Expenditures - Health Systems Facts

Total Health Spending, USD PPP Per Capita (2019): $5,376

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2021), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 20 January 2021).

Current Health Expenditure Per Capita (USD) (2016): $4,263
Current Health Expenditure as Percentage of Gross Domestic Product (%) (2016): 11.5%
Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2016): 17.0%
Population with household expenditures on health greater than 10% of total household expenditure or income (2009-2015) (%): NA
Population with household expenditures on health greater than 25% of total household expenditure or income (2009-2015) (%): NA

Source: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.

Annual out-of-pocket payment, constant (2017) PPP per capita (USD) (2017): $470

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Oct. 6, 2020.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 2.0%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“Health spending as a share of GDP increased over the last decade from 10.3 % in 2007 to 11.3 % in 2017, the highest share in the EU along with Germany and well above the EU average of 9.8 % (Figure 7). However, France only comes in sixth place in terms of health spending per capita, at EUR 3 626 per capita in 2017 (adjusted for differences in purchasing power). While this is 25 % above the EU average (EUR 2 884), several countries such as Germany, Austria, Sweden, the Netherlands and Denmark spend more.”

Source: OECD/European Observatory on Health Systems and Policies (2019), France: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“The largest category of health spending in France is inpatient care provided in public and private hospitals, which accounted for about one-third of all health spending in 2017, a share higher than the 29 % EU average (Figure 8). Over one-fourth of health spending was allocated to outpatient care, including primary care, specialist care and dental care. Retail pharmaceuticals and medical devices made almost one fifth of health spending, and long-term care over one seventh. Spending on prevention accounted for less than 2 % of all health spending, a share lower than the 3.1 % EU average, but this only includes spending dedicated to organised prevention programmes.”

“In France fee-for-service physician payment occurs within budget constraints set by parliament and the Ministry of the Economy and Finance. UNCAM [Union Nationale des Caisses d’Assurance Maladie] negotiates fees with representatives of the physicians unions. All physicians in the community and in private for-profit hospitals are reimbursed according to this fee schedule. Most public hospital physicians are paid on a part-time or full-time salaried basis. Although the state is not officially involved, it closely monitors the negotiations between UNCAM and the physicians unions.”

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.

“As a result of fee negotiations within expenditure targets, physicians in all three countries earn lower incomes than their US counterparts. For example, in 2016 generalist physicians in the US earned an average of $218,173. In comparison, generalists in France and Germany earned $111,769 and $154,126, respectively. Similarly, specialist physicians in the US earned an average of $316,000 in 2016, compared with $153,180 in France and $181,253 in Germany.³ Japanese physicians earned, on average, $124,558 in 2016; however, this is an average of generalist and specialist incomes.

“Policy makers in the US have been concerned that fee-for-service payment results in an excessive volume of services. The French response to excess volume was to impose expenditure targets in 1996 and 2010, but France exceeded its budget targets frequently.^12,25 Within the past decade physician fee increases and total annual spending have been held in line. This success reflects tighter political control by parliament, the Ministry of the Economy and Finance, and the Ministry of Social Affairs and Health, which has made budget constraints explicit for UNCAM [Union Nationale des Caisses d’Assurance Maladie] in negotiations with physicians unions.”

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 several other nations.

Page last updated Feb 28, 2021 by Doug McVay, Editor.