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“The present system of social security, including SHI [Statutory Health Insurance], was established after the Second World War. Prior to this, healthcare and social care were largely provided through mutual benefit associations. The statutory insurance system first emerged with the 1930 Act on Social Insurance, which created a system of compulsory protection paid for by employers for employees whose earnings fell below a certain level. Coverage encompassed five areas: illness, maternity, disability, old age and death. By 1939 two thirds of the French population was covered for illness by mutual benefit associations, with free choice of the organization providing coverage. The creation of SHI in 1945 within the social security system changed the role of these associations, which either disappeared or became providers of complementary private health insurance (CHI), which is a type of co-insurance in France (see Section 3.5).

“Social security consists of compulsory protection, with four branches covering health (disease, maternity, incapacity and death),work-related illness and injuries. SHI is the branch of social security covering health, initially funded by contributions from both employers and employees, with benefits provided in cash and in-kind. While the founders of the social security system, largely inspired by the Beveridge report in the United Kingdom, aimed to ensure uniform rights for all, this was opposed by certain social professional groups that already benefited from insurance coverage with more favourable terms. Several of them succeeded in maintaining their particular systems, which were transformed into small SHI schemes. However, today, the main SHI schemes cover over 90% of the population (see Section 3.3.1).”

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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“Initially, the SHI [Statutory Health Insurance] covered workers and their families only. However, the principle of expanding coverage to the whole population had been raised as early as 1945 but was only put into practice in stages (for more details, see Section 2.2 in Chevreul et al., 2010). The shift from an employment-based system towards universal health coverage was nearly achieved with the 1999 Universal Health Coverage Act (couverture maladie universelle, CMU), which instituted a residency-based right to SHI coverage (see Section 3.2 in Chevreul et al., 2015), while in parallel, funding methods on the beneficiary side have shifted from an employee earned income-based contribution to an earmarked tax on every type of revenue (Contribution sociale généralisée, CSG) (see Section 3.3.2).”

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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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 February 12, 2025 by Doug McVay, Editor.