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“The present system of social security, including SHI, was established after the Second World War. Prior to this, health and social care were largely provided through mutual benefit associations. The statutory 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 [Statutory Health Insurance] in 1945 within the social security system changed the role of these associations, which either disappeared or became providers of VHI (see section 3.3.2).
“Social security consists of compulsory protection, with four branches covering health, work-related illness and injuries, retirement and family. SHI is the branch of social security covering health (disease, maternity, incapacity and death) and is 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, three main SHI schemes cover 95% of the population (see section 2.3.5).”
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 shift from an employment-based system towards the CMU [Universal Health Coverage] system was nearly achieved with the 1999 Universal Health Coverage Act (Loi No. 99–641 du 27 juillet 1999 portant création d’une couverture maladie universelle), which instituted a residency-based right to SHI coverage and created the CMU Fund (Fonds CMU; see section 3.2) to provide free public coverage for individuals whose incomes fall below a certain level; individuals above this threshold who are not entitled to SHI on an occupation basis must pay a share of their income to be covered on a voluntary basis by SHI. Undocumented immigrants are not eligible for access through CMU. However, those who have lived in France for at least three months are eligible for free coverage under the state medical assistance (aide médicale de l’état; AME) (see section 3.3.1). In parallel, from the late 1990s, funding methods on the beneficiary side have shifted from an earned income-based social contribution to an earmarked tax, the CSG (see section 3.3.1).”
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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Page last updated Oct. 25, 2022 by Doug McVay, Editor.
