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“Recent reforms in France have focused on four main areas: improving financial access to care to avoid forgone care; improving physical access, particularly in underserved areas; strengthening prevention; and reforming payment methods for care providers.

“Improving financial access to care has included better coverage – via the “100% Santé” reform in 2020 – of OOP [Out-Of-Pocket] payments for optical devices, dental care and hearing aids – as well as better coverage of mental health care by reimbursing psychologist visits under certain conditions. Improving physical access meant increasing the number of training places for medical students, improving the territorial organization of health services, supporting task sharing, and forming new health professions to address workforce shortages.

“Measures for reinforcing prevention in the system included a change in medical education requiring all healthcare students to practice health promotion and prevention activities as part of their training, and free prevention consultations for key age groups (teenagers for sexual issues, older people at retirement, etc.) as well as extended mandatory vaccination for children. However, these measures have not been linked to a major increase in primary prevention funding.

“Future reforms focus mainly on promoting better coverage and equity in access to care and prevention, and continuing the reforms of primary care and provider payment.”

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 accountability and transparency of the French health system have improved over the past decade, following major adverse events which exposed deficiencies in healthcare governance. Patients’ rights have been strengthened, but there is little information to guide patients through the health system and patients have low participation in treatment decisions.

“Financial accessibility to healthcare is generally high in France. All residents are covered by universal health insurance, and they have access to a broad benefits package. OOP payments and catastrophic health spending are among the lowest in the EU; however, there are significant geographic inequalities in access to care because of the unequal distribution of the health workforce across the country.

“France performs well in terms of all-cause mortality, life expectancy and mortality from treatable causes. However, there is a limited focus on health promotion, disease prevention and behavioural risk factors, which is reflected in relatively higher preventable mortality rates. Further, large inequalities in health outcomes between regions, socioeconomic classes and gender persist in the country.”

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 future challenges facing the French health care system are underscored by the measures planned for the 2015 Health Reform Law: on the one hand, improvements in the organization of care to meet the needs of an ageing, increasingly chronically ill population while combating inequalities through improved efficiency and equity in financing and geographic access; and on the other hand, the reform of long-term care to preserve the autonomy of elderly individuals and facilitate ageing at home while reducing the financial and care burdens on families.”

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.

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“The French health system still relies mainly on activity-based payments (fee-for-services for doctor consultations and diagnostic-related group payments for hospital services). While these payment methods create incentives to increase the quantity of care provided, they do not necessarily promote care coordination or reward quality and appropriateness.

“Recent government proposals are designed to experiment new payment methods in primary care and hospital to better respond to the growing burden of chronic diseases by providing greater financial incentives for care coordination and quality and giving less weight to activity-based payments. Starting in 2020, a selection of hospitals will test replacing the current activity-based payment system for hip and knee replacement and colectomy with an episode-based bundled payment system. Similarly, some primary care centres will be paid on a capitation basis and incentives towards local care integration will also be introduced. All these initiatives draw from international best practices.”

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.

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“The so-called medical deserts have been a priority on the political agenda for over two decades. However, because French physicians have freedom of settlement, it is challenging to address this issue. Coercive measures were considered but abandoned because of the significant political power of doctors, and financial incentives have been generally unsuccessful. Government reform efforts have shifted to multidisciplinary practice models, task transfer and the use of information technologies such as tele-health as means of compensating for lower physician density, particularly in rural areas. Moreover, promising initiatives focusing on improving the workplace quality of life of doctors have flourished at the local level.”

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.

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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 and policies in the US and sixteen other nations.

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Page last updated February 12, 2025 by Doug McVay, Editor.