Healthcare in France

The healthcare system in France is considered one of the best in the world. It frequently makes a variety of best overall healthcare lists. France has a high life expectancy of 83, low mortality rates and the people are generally satisfied with their healthcare. Universal health coverage in France was achieved over many decades starting in 1945 when employees and retirees had access to health insurance. Then in 1966 it was expanded to the self-employed, again in 2000 with access for the unemployed and most recently in 2016 with the creation of Universal Health Protection Law (PUMa) that closed any coverage gaps. Today the healthcare system in France is a hybrid system with healthcare costs financed partially by the state and partly by the individual. 

Healthcare in France is considered a national responsibility. The Ministry of Social Affairs, Health and Women’s Rights is responsible for creating the national health strategy. It is responsible for setting and implementing government policy for public health and for the organizing and financing of the healthcare system. In regions, the Regional Health Agencies are responsible for coordinating population health and healthcare. General practitioners act as gate keepers for their patients. They refer patients to specialists and hospitals when needed. Patients are free to choose their reference doctor and there is financial incentives for going through your GP instead of going directly through another doctor. In France there is the health insurance card called Carte Vitale. It links to all your medical and administrative information as well as to your health insurance provider. It also sends your treatment and payment information to the Social Security system.  

France spends around 11.3% of its GDP on healthcare which is higher than average for the region and richer countries. The insurers are non-profit agencies and they are responsible for negotiating with the state for the overall funding of healthcare. Funding is provided through a variety of taxes. Payroll taxes provide 53% with employers paying 80% and employees paying the rest. Income tax contributes 34% and other taxes on things like alcohol and tobacco providing 12%. The 2001 Social Security Funding Act set the rates for health insurance at 5.25% of earned income and at 3.95% of benefits. Healthcare coverage and insurance in France is compulsory for all residents. It generally has low costs for the patients and a high amount of coverage.  

Covered services and the fee schedule are typically defined by the Ministry of Social Affairs, Health, and Women’s Rights and the National Union of Health Insurance Funds. Services covered includes outpatient care, hospital care, prescriptions, rehabilitation care, maternity care through 6 months post-partum and newborn care, among others. There is also partial coverage for long-term care and mental health, as well as minimal coverage for dental and vision. The healthcare system will typically cover about 70% of the fees and 80% of hospital costs. If you have a major illness, 100% of the expenses are covered. Out-of-pocket spending make up around 7% of total health expenditures. Most of it is for dental and vision services. People with low incomes are entitled to free or discounted health insurance, free vision and dental care. There is private, voluntary insurance which is usually in the form of complementary insurance through employers. They mainly cover copayments, balance-billing, vision and dental. Employees are responsible for 50% of the cost. Around 95% of the population has voluntary insurance. 

France is also doing a lot to reduce any disparities with care. The 2004 Public Health Act set targets for reducing geographic and financial inequities in healthcare. Disparities are being addressed through physician contracts. Financial incentives encourage physicians to practice in underserved areas. Also, physician contracts prohibit physicians from denying care to beneficiaries of state-sponsored health insurance and put a cap on balance billing. Despite the perception from other countries that the wait times are long, there is usually only a little or moderate wait. There has been some increase in cost and a decrease in reimbursements lately to help cover the rising cost of healthcare. Also, the French seem not to be bothered much by the high taxes for healthcare and are very proud of their healthcare system.