OVERVIEW OF FRANCE’S NATIONAL HEALTHCARE SYSTEM

Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2017):
Public Coverage: 99.9%; Primary Private Health Coverage: %; Total: 99.9%

Note: “Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”)”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Annual household out-of-pocket payment, current USD per capita (2017): $411

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Oct. 6, 2020.

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 2.0%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“The health system provides near universal coverage through a publicly financed statutory health insurance scheme. The publicly financed benefits package is considered generous in terms of the scope of its coverage, but user charges are applied to most services, mainly in the form of coinsurance (except for treatment for chronic conditions covered by the affections de longue durée (ALD) scheme).

“Patients have access to public and private hospitals. Hospital treatment requires 20% coinsurance from patients. Coinsurance is not needed for costly surgeries. Patients also pay a lump sum per day in hospital for food. Outpatient care involves three types of user charges: coinsurance, extra-billing and deductibles. Coinsurance rates are 30% for physician and dentist care and 40% for ancillary services and laboratory tests. For most medicines, coinsurance amounts to either 70 or 35%, but ranges from 0% for non-substitutable or expensive medicines, to 85% for so-called convenience medicines. Some outpatient specialists use extra-billing.”

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.

“France’s health system is based mainly on a social health insurance (SHI) system, with a traditionally strong role for the state. The single-payer system increasingly relies on tax-based revenues to ensure the financial sustainability of health insurance funds. In the past two decades, the state has become more involved in controlling health expenditure funded by the SHI system. Since 2009, the regional health agencies have played an expanding role in managing health care provision at the local level.

“The National Health Strategy 2018-22, adopted in 2017, sets ambitious goals covering both prevention and health care (Box 1).”

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.

“The French health care system is structurally based on a Bismarckian approach, with goals of universality and solidarity that have led to an increasingly Beveridge style of system. SHI [Social Health Insurance] currently covers almost 100% of the resident population.”

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 French health care system was initially organized according to a Bismarckian model of provision and payment for health care. However, it has developed into a mixed Beveridge and Bismarck model, characterized by an almost single public payer, the increasing importance of tax-based revenue for financing health care and strong state intervention. SHI is financed by employer, employee and retiree contributions, increasingly substituted by earmarked income taxes. Providers of outpatient care are largely private, while hospital beds are predominantly found in public or private non-profit-making hospitals.

“In the context of increasing health care expenditure, the increasing deficit of SHI [Statutory Health Insurance] and the overall social security system, the role of the state in steering the system through regulation has increased since the early 1990s. Regulation, therefore, involves negotiations among provider representatives (hospitals and health professionals), the state, represented by both the Ministry in charge of Health, the Ministry in charge of the Budget and Public Accounts, and SHI. The outcome of these negotiations is translated into administrative decrees and laws passed by the parliament. These include public health acts and acts related to social security funding and reforms.”

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.

“France has more than 600 mostly private nonprofit and for-profit complementary insurers (similar to Medigap coverage in the US) that provide partial reimbursement for out-of-pocket expenses for the same benefit package covered under universal health insurance and for supplementary benefits, mostly dental and optician services. Employers are required to offer and finance half of the premium costs to provide a minimal level of complementary health insurance for their salaried employees. For those below a poverty income ceiling, a minimum package of complementary insurance benefits is available without premium charges; this covers all coinsurance payments for physicians who accept universal health insurance tariffs as payment in full. Unemployed people maintain their usual coverage, as there is no “job lock,” and their complementary insurance is ensured for up to one year of unemployment.”

Source: Michael K. Gusmano, Miriam Laugesen, Victor G. Rodwin, and Lawrence D. Brown. Getting The Price Right: How Some Countries Control Spending In A Fee-For-Service System. Health Affairs 2020 39:11, 1867-1874.

“The general philosophy underlying decentralization in France reflects a marked reluctance to reduce central control over policy and finance, and as a result, it has mainly come in the form of deconcentration. The creation of the ARSs [Regional Health Agencies] in 2010 changed the regional landscape by merging seven regional institutions (see section 2.4 in Chevreul et al., 2010) into a single regional entity traversing the traditional boundaries of health care, public health and health and social care for elderly and disabled people.

“The 26 ARSs are responsible for ensuring that the provision of health care services meets the needs of the population by improving the coordination between the ambulatory and hospital sectors and health and social care sector services, while respecting the ONDAM [National Ceiling for Statutory Health Insurance [SHI] Expenditure] (see section 3.3.3). They are also responsible for implementing regional health policy in relation to occupational health services, mother and child health protection services (protection maternelle et infantile; PMI), and university and school health services.

“The ARSs monitor the regional health status of the population, ensure that hygiene rules are respected, participate in prevention and patient health education and assess health professionals’ education. They also carry out SHI regional programmes, notably in risk management. They authorize the creation of new health services and social and health services for the elderly and disabled. In the environment and health sector, they oversee water and air quality.”

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.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Sept 20, 2021 by Doug McVay, Editor.