France: health system review
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World Health Organization. Regional Office for Europe
Abstract
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218 p.
This analysis of the French health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. The French populationhas a good level of health, with the second highest life expectancy in theworld for women. It has a high level of choice of providers, and a high level ofsatisfaction with the health system. However, unhealthy habits such as smokingand harmful alcohol consumption remain significant causes of avoidablemortality. Combined with the significant burden of chronic diseases, this hasunderscored the need for prevention and integration of services, although thesehave not historically been strengths of the French system.Although the French health care system is a social insurance system, ithas historically had a stronger role for the state than other Bismarckian socialinsurance systems. Public financing of health care expenditure is amongthe highest in Europe and out-of-pocket spending among the lowest. Publicinsurance is compulsory and covers the resident population; it is financed byemployee and employer contributions as well as increasingly through taxation.Complementary insurance plays a significant role in ensuring equity in access.Provision is mixed; providers of outpatient care are largely private, and hospitalbeds are predominantly public or private non-profit-making.Despite health outcomes being among the best in the European Union, socialand geographical health inequities remain. Inequality in the distribution ofhealth care professionals is a considerable barrier to equity. The rising cost ofhealth care and the increasing demand for long-term care are also of concern.Reforms are ongoing to address these issues, while striving for equity infinancial access; a long-term care reform including public coverage of long-termcare is still pending.
This analysis of the French health system reviews recent developmentsin organization and governance, health financing, health care provision,health reforms and health system performance. The French populationhas a good level of health, with the second highest life expectancy in theworld for women. It has a high level of choice of providers, and a high level ofsatisfaction with the health system. However, unhealthy habits such as smokingand harmful alcohol consumption remain significant causes of avoidablemortality. Combined with the significant burden of chronic diseases, this hasunderscored the need for prevention and integration of services, although thesehave not historically been strengths of the French system.Although the French health care system is a social insurance system, ithas historically had a stronger role for the state than other Bismarckian socialinsurance systems. Public financing of health care expenditure is amongthe highest in Europe and out-of-pocket spending among the lowest. Publicinsurance is compulsory and covers the resident population; it is financed byemployee and employer contributions as well as increasingly through taxation.Complementary insurance plays a significant role in ensuring equity in access.Provision is mixed; providers of outpatient care are largely private, and hospitalbeds are predominantly public or private non-profit-making.Despite health outcomes being among the best in the European Union, socialand geographical health inequities remain. Inequality in the distribution ofhealth care professionals is a considerable barrier to equity. The rising cost ofhealth care and the increasing demand for long-term care are also of concern.Reforms are ongoing to address these issues, while striving for equity infinancial access; a long-term care reform including public coverage of long-termcare is still pending.