Population, Midyear 2022: 64,626,628
Population Density (Number of Persons per Square Kilometer): 117.21
Life Expectancy at Birth, 2022: 83.23
Infant Mortality Rate, 2022 (per 1,000 live births): 3.30
Under-Five Mortality Rate, 2022 (per 1,000 live births): 3.91
Projected Population, Midyear 2030: 65,543,453
Percentage of Total Population Aged 65 and Older, Midyear 2022: 21.66%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 24.42%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 28.55%
Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.
Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2019):
Public Coverage: 100%; Primary Private Health Coverage: %; Total: 100%
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 (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
Annual household out-of-pocket payment, current USD per capita (2019): $416
Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed April 7, 2022.
Out-of-Pocket Spending as Share of Final Household Consumption (%) (2019): 2.0%
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-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. While regional health agencies have played a greater role in managing health care provision at the local level since 2009, SHI and central government have always played a strong role in organising the health system and determining its operating conditions. Over the past two decades, the state has also become more involved in controlling health expenditure funded by the SHI system by setting a national health spending target. The governance structures established to manage the COVID-19 pandemic were piloted at the national level (Box 1).”
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.
“The French healthcare system is structurally based on a Bismarckian (SHI) [Statutory Health Insurance] approach, with goals of universality and solidarity that have led to an increasingly Beveridgian-type (NHS) [National Health Insurance] system. The SHI currently covers 100% of the resident population (including undocumented migrants under certain conditions). Jurisdiction over health policy and regulation of the healthcare system (Fig. 2.1) is divided among:
“ the State: parliament and the government, specifically the Ministry of Health3
“ the SHI; and
“ to a lesser extent, local authorities (départements).
“Delivery of care is shared among private, fee-for-service (FFS) physicians and other health professionals, private for-profit hospitals, private non-profit hospitals and public hospitals. The current institutional organization of the health system is the result of the will of the founders of the social security system to create a single block system, guaranteeing uniform rights for all. Health insurance in France has, therefore, always been more concentrated and uniform than in other Bismarckian systems.”
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.
“The SHI [Statutory Health Insurance] is composed of three categories of schemes, which cover the entire population. Individuals and their families are affiliated with a scheme based on employment status. Working people have no choice regarding the scheme in which they are enrolled and may not opt out of coverage except in certain cases (for example, expatriates and employees of international corporations or institutions). Thus, there is no competition among the schemes. Persons who are not working are automatically enrolled in the general scheme, which is the major scheme.
“The three categories of schemes and their beneficiaries in 2020 are approximately as follows:
“1. the general scheme (Caisse nationale d’assurance maladie, CNAM)covers everybody (around 88% of the population) except thoseeligible for other schemes (CNAM, 2021k);
“2. the agricultural scheme (Mutualité sociale agricole, MSA) coversfarmers and agricultural employees and their families (around 5% of the population); and
“3. the numerous “special schemes”, over 20 in number, built upon preSHI prepayment systems for defined categories of workers: localand national civil servants, miners, military personnel, employees of the national railway company, the clergy, sailors, the national bank, the gas and electricity company (they cover 7% of the population but technically manage claims and benefits for hardly 3%) (UNRS,2022) (see Section 3.3.1).
“These schemes are federated into a National Union of Health Insurance Funds (Union nationale des caisses d’assurance maladie, UNCAM) for the purpose of representing the funds in negotiations with healthcare providers.
“Each of the two major health insurance schemes is made up of a national health insurance fund and local structures corresponding to the degree of geographical distribution involved.”
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.
“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 ARS [Regional health agency, Agence régionale de santé] in 2010 changed the regional landscape by merging seven regional institutions into a single regional entity traversing the traditional boundaries of healthcare, public health, and health and social care for elderly and disabled people.
“The 18 ARS (13 for mainland France and 5 for overseas departments) are responsible for ensuring that the provision of healthcare 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 national objectives for SHI spending (ONDAM). It is also responsible for implementing regional health policy in relation to occupational health services, maternal and child protection services (Protection maternelle et infantile, PMI), and university and school health services.
“The ARS 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 authorize the creation of new health services and social care services for the elderly and disabled. In the environmental health sector they oversee water and air quality.”
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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Page last updated August 11, 2023 by Doug McVay, Editor.
