---

Health expenditure by type of financing, 2021
– Government schemes: 4%
– Compulsory health insurance: 81%
– Voluntary health insurance: 6%
– Out-of-pocket: 9%
– Other: 1%
Out-of-pocket spending on health as share of final household consumption, 2021: 2.2%
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 83%
– Voluntary health insurance schemes: 5%
– Out-of-pocket spending: 12%
– Other: 0%
Total long-term care spending by provider, 2021
– Nursing home: 61%
– Hospital: 7%
– Home care: 24%
– Households: 0%
– Social providers: 0%
– Other: 7%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

---

“The SHI [Social Health Insurance] system offers coverage to the whole population based on residence through various compulsory schemes. Revenue for healthcare comes from social security contributions, earmarked income taxes, value-added taxes and other sources such as tobacco and alcohol taxes.

“Nearly everyone (95%) has complementary health insurance, mainly to cover copayments and to attain better coverage for medical goods and services that are poorly covered by the SHI system, such as dental and optical care (although since 2021 public coverage for dental and optical care has improved substantially (see Section 5.2)). In 2021, public and private compulsory complementary health insurance schemes funded 85% of all health spending in France – higher than the EU average of 81%.⁵“

Source: OECD/European Observatory on Health Systems and Policies (2023), France: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

---

“Since 1998, employees’ payroll contributions have been progressively replaced by an earmarked tax on all sources of income and have fallen from 6.8% to 0.75% of gross earnings in 2013. As a result of attempts to broaden the social security system’s financial base, employee’s contributions have been mainly substituted by the earmarked CSG [General Social Contribution] introduced in 1991. The CSG rate varies depending on the source of income. Initially it was a two-tier rate but slowly evolved to a range, with higher rates for revenue from capital or from games of chance and a lower rate for revenue from those with low incomes. It is 7.5% on earned income (of which 5.29 percentage points goes to SHI [Statutory Health Insurance]), 8.2% on capital (5.95 percentage points for SHI), up to 12% on gambling winnings, 6.6% on pensions (4.35 percentage points for SHI) and 6.2% on benefits (e.g. unemployment and sick leave allowances) (3.95 percentage points for SHI). The rate decreases to 3.8% of earned income for individuals with low incomes who were otherwise exempt from income taxation, which represent nearly half of French households. Moreover, because the revenue base of SHI has been broadened and partly disconnected from earnings, it is less vulnerable to wage and employment fluctuations. A share of CSG contributions is generally deductible from income tax. In 2012, 70% of the revenues from the CSG went to the SHI schemes, accounting for 35% of their financing.

“The pharmaceutical industry is also required to contribute through a 1.6% tax on their turnover, a tax on advertising, a tax on drug retailing and an additional tax if their turnover exceeds a limit set in the Social Security Finance Act. In 2012, these taxes raised €1.04 billion for SHI. Additional revenue for SHI is levied on the profits of companies with turnover of more than €760 000. This 0.13% tax is estimated to have levied €55 million in 2013. Other taxes are levied on polluting activities of companies. In 2012, employers’ contributions, employee’s contributions and CSG revenue accounted for 82.3% of total SHI revenue. The remainder was provided mainly through state subsidies and additional earmarked taxes (e.g. on tobacco and alcohol consumption).”

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.

---

“In 2014, public spending accounted for over three-quarters of total spending on health (78.2%), while VHI [Voluntary Health Insurance] accounted for 13.3% and OOP [Out Of Pocket] payments for 6.3% of total spending on health – making France one of the three largest VHI markets in Europe (WHO, 2016).”

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.

---

---

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 and policies in the US and sixteen other nations.

Page last updated January 15, 2025 by Doug McVay, Editor.