French Health System Overview
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Health System Expenditures
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“In 2019, public and private compulsory health insurance schemes funded 83.7 % of all health spending in France6 – higher than the EU average of 79.7 %. The revenue for these schemes comes mainly from social security contributions paid by employers and employees, income taxes and additional sources such as taxes on tobacco and alcohol.
“Since 1996, annual growth in SHI expenditure has been controlled by the national health spending target. It remained constant at around 2.5% growth per year in 2009-19, but grew by 9.5 % in 2020 due to additional spending related to the pandemic and the introduction of a new investment plan to strengthen public hospitals (see Box 2 and Section 5.3).”
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.
“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.
“The state finances 4.9% of total expenditure on health (Fig. 3.6), and only 1.2% of expenditure related to personal health care consumption. The state finances activities in the areas of prevention (28% of state expenditure), medical research (30%), training of medical professionals (15%) and administrative costs of the health care system (7%). Other budget allocations are directed to the AME programme (see section 3.3.1), military hospitals, services for disabled veterans and emergency care (5%). Additionally, 14% of the state expenditure is directed to the CMU Fund for beneficiaries of CMU-C under the SHI funds (see section 3.5.4).
“Finally, the state also participates in SHI funding by subsidizing the exemption of employers’ SHI contributions in order to encourage employment of low-wage workers in domiciliary support services or in defined areas.”
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.
“In 2014, public spending accounted for over threequarters 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.
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Page last updated Dec. 3, 2022 by Doug McVay, Editor.
