Question

What is the health status of the French population?

Answer 1

The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "close to best overall health care" in the world. In 2011, France spent 11.6% of GDP on health care, or US$4,086 per capita, a figure much higher than the average spent by countries in Europe but less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.

Most general physicians are in private practice but draw their income from the public insurance funds. These funds, unlike their German counterparts, have never gained self-management responsibility. Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded). The French government generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until 2000, coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place universal health coverage and extended the coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and dental care (35.9%) (figures from the year 2000). There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals.

Healthcare System

The entire population must pay compulsory health insurance. The insurers are non-profit agencies that annually participate in negotiations with the state regarding the overall funding of health care in France. There are three main funds, the largest of which covers 84% of the population and the other two a further 12%. A premium is deducted from all employees' pay automatically. The 2001 Social Security Funding Act, set the rates for health insurance covering the statutory health care plan at 5.25% on earned income, capital and winnings from gambling and at 3.95% on benefits (pensions and allowances).

After paying the doctor's or dentist's fee, a proportion is reimbursed. This is around 75 to 80%, but can be as much as 100% (if you have a long duration medical problem such as a cancer). The balance is effectively a co-payment paid by the patient but it can also be recovered if the patient pays a regular premium to a voluntary health insurance scheme (more than 99% of the population as every worker is entitled, per law, to access to a company subsidized plan). Most of them are managed by non-for-profit groups.

Under recent rules (the coordinated consultation procedure, in French: "parcours de soins coordonné"), general practitioners ("médecin généraliste" or "docteur") are expected to act as "gate keepers" who refer patients to a specialist or a hospital when necessary. However the system offers free choice of the reference doctor, which is not restricted to only general practitioner and may still be a specialist or a doctor in a public or private hospital. The goal is to limit the number of consultations for the same illness. The incentive is financial in that expenses are reimbursed at much lower rates for patients who go directly to another doctor (except for dentists, ophthalmologists, gynaecologists and psychiatrists); vital emergencies are still exempt from requiring the advice from the reference doctor, which will be informed later. As costs are borne by the patient and then reimbursed (most of the time on the spot as all doctors and drugstores can read the "Carte Vitale", a smart card with all information on the patient and the co-insurance company), patients have freedom of choice of where to receive health care services.

Around 62% of hospital beds in France are provided by public hospitals, around 14% by private non-profit organizations, and 24% by for-profit companies.

Minister of Health and Solidarity is a cabinet position in the government of France. The healthcare portfolio oversees the public services and the health insurance part of Social Security. As ministerial departments are not fixed and depend on the Prime Minister's choice, the Minister sometimes has other portfolios among Work, Pensions, Family, the Elderly, Handicapped people and Women's Rights. In that case, they are assisted by junior Ministers who focus on specific parts of the portfolio.