The French Health System

Ana Lee Silva Gabriele Pérez

Sofia Lopez
Background
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Principles of the French Health System
•Universality > mandatory social protection for all
nationals and residents
•Globality > covers various aspects of life (health,
maternity, old age, disability, work accidents and
occupational diseases, family benefits,
dependency, and also unemployment
•Solidarity > collective financing
•Joint management-) social protection
organizations are administered by representatives
of the insured and are under the supervision of
the State
The state
• Itentire
is responsible for providing health coverage to the
population.
• Responsible for public safety.
• Dictates the types of care that will be reimbursed
• Responsible for protecting patient rights, developing
policies and enforcing them
• Develop a regional public health management plan,
the size and numbers of hospitals.
The state
• 75% of total health expenses are covered by the
public health insurance system
State Agencies
• Biomedicine Agency,
• French Food Safety Agency (AFSSA),

• French Agency for Health Safety of Health Products (AFSSAPS),

• French Environmental Health Safety Agency (AFSSE),
• National School of Public Health (ENSP),
• French Blood Establishment (EFS)
• High Health Authority (HAS),

• National Institute for Prevention and Health Education (INPES),

• Health Surveillance Institute (InVS),
• Institute of radioprotection and nuclear safety (IRSN).
Present
• First place out of 193 WHO member countries
• The five indicators used:
• overall level of health of the national
population
• level of inequality between sectors
• distribution of health system costs between
different sectors
• response capacity of the health system
• level of satisfaction of the different
sectors served by the system
Statistical data (2008)
• Total population: 61,330,000

• Gross national income per capita (in international dollars): 32,240

• Life expectancy at birth h/m (years): 77/84

• Healthy life expectancy at birth h/m (years, 2003): 69/75

• Probability of dying before reaching the age of five (per 1000 live births): 5

• Probability of dying between 15 and 60 years, m/m (per 1000 inhabitants): 124/57

• Total health spending per inhabitant ($int, 2006): 3,554

• Total health spending as a percentage of GDP (2006): 11.1

France vs USA

Comparison of health systems

Source: OECD (2003), "Health-Care Systems"

total expenditure) total expenditure ) beneficiary (% total expenditure)

□ France ■ United States •OECD

Health insurance
• Mandatory membership.
• Disease risks are covered by this.
• Generally for work: insured (employee)
and beneficiary (family member).

• It is carried out by various regimes.

◦ The most important: Social Security
The Social Security regime
• It covers workers in industry, commerce
and services and their families = 80% of the
population.
• Levels:
◦ National Health Insurance Fund for Salaried
Workers.
◦ Regional Health Insurance Funds (16).
◦ Primary Health Insurance Funds (128).
Other regimes…
• Agricultural Social Mutuality.
◦ Farmers and their families = 9%
• Social Regime of the Self-Employed.
◦ Artisans, merchants, independent professionals
= 6%
• Others:
◦ Mines.
◦ National Railway Society.
◦ Sailors.
Where do they get the money for
insurance?
• Of the workers' contribution = 80%.
◦ Company and Worker.

• Generalized Social Contribution.

◦ Deducted from salary, 0.5%

• the
Of the Contribution for the Repayment of
Social Debt.
◦ Deducted from salary, 7.5%
Complementary
Insurance
• Serious illnesses, maternity, accidents =
full coverage.
• Health Insurance reimburses a part but
leaves an expense to the patient (ticket
moderateur)

Complementary Insurance
(shared fee between company and worker)
Universal Disease
Infrastructure andCoverage
services
• Covers:
◦ People who do not have the right to Health
Insurance (elderly, disabled, refugees)
◦ People who benefit from Health Insurance, but
whose low income does not allow them to acquire
Supplementary Insurance

• In total: 4.3 million people

• HEALTH CENTERS
◦ Public and private hospitals
◦ There are 3000.
◦ One third is public and two thirds is private.
◦ They depend on the municipalities.
• CONSULTATIONS
◦ The majority have public status and salaried
workers
Infrastructure and
services
◦ General or specialized assistance
Public hospitals are organized into several categories:

• 31 regional hospital centers

(CHR), among which 29 are also
university hospital centers
(CHRU),
• 562 general hospital centers,
• 349 local hospitals, established in small
cities and rural areas.
• Service de Santé des Armées, under the
direction of the Ministry of Defense
Infrastructure and
services
• HEALTHCARE PROFESSIONALS
◦ 1.7 million jobs.
or 76% occupied by women.
◦ 2 categories:
- Medical professions (doctors, specialists, dentists,
pharmacists)
- Paramedical professions (nurses, assistants,
technicians)
- 47% work in the public hospital sector
- 53% in the private hospital sector
 Healthcare professionals
Infrastructure and
services
Indicator Value (year)
Otontologists (density per 1,000 inhabitants) 2 7.00 (2006)
Otontologists (number^ ? 41,374 (2006)
Nurses ( number) ? 486,006 (2006)
Pharmacists (number) ? 69,431 (2006)
Doctors (number) ? 207,277 (2006)
Nurses (density per 1,000 inhabitants) ? 80.00 (2006)
Pharmaceuticals (density per 1,000 inhabitants) ? 11.00 (2006)
Doctors (density per 1,000 inhabitants) ? 34.00 (2006)
• PHARMACY.
◦ Public power regulates production and
distribution.
◦ They are private companies.
◦ Distributed throughout the territory according to
demographic norms set by the government.
• MEDICINES.
◦ French: top consumers in the world.
◦ The government pushes the generics they own to
Infrastructure and
services
save money on reimbursements.
Financing
◦ The Social Security system is financed by
working people
◦ They pay approx. 20% of your salary
◦ Those who work for themselves pay more - A
portion of this money goes to the public health system (a
right for all citizens)
News
• Since November 2007, those who do not
work or are retired, or are covered by the
government of another country, will not be
able to access the French system; until:
◦ Reach retirement age
◦ They live in the country for 5 years (minimum)

◦ For now they need private insurance

Social Security System
•When a person joins the Social Security
system, part of their medical expenses are
covered by the government through
reimbursement
• Regardless of coverage,
◦ Anyone can consult with any specialist or doctor
◦ Everyone has the right to urgent care
Public vs. Private
• There is not much difference between the
quality, prices and services of public and
private hospitals.
• When consulting a doctor, you must pay for
the full service, and then you receive
reimbursement (approx. 10 days later)
Refund
•For basic services (consultations,
pharmacies) it is normal for the person to
pay the total, and then receive the refund
•Approx. 10 days; directly to your bank
account
•For more complex and expensive services
(hospitalizations) the insurance pays
directly
Refund
• General Physician/specialist: 70%
• Surgery: 95%
• Minor Surgery: 80%
• Pregnancy/Childbirth: 95-100%
• Medication (w/ Rx): 15%, 35%, 65%
• X-rays: 70%
Refund
• Dentist: 70%
• Nursing care in case: 70%
• The refund will be 100% if:
◦ You have 1 or more than 30 acute/chronic
diseases
◦ Diabetes, cancer, heart disease
◦ You require long-term care, or for a long-term
condition
Refund
◦ You are in the hospital for more than 30 days
(from day 31, reimbursement is 100%)
◦ Surgery costs are greater than € 91 ($150 pesos)
oTo receive 100% coverage, the doctor must
record the condition and the patient will
receive a certification letter
L They must present this full coverage letter
every time they receive treatment or
purchase medication
Issues
• Increase in cost of medicine
• Older population
• Unemployment growth
◦ Less money for government insurance
Obstacles
• The population sees access to health
services as a right
• If the country provides less coverage, or
demands more money, people will disagree
Conclusio
n• More than 60 years of experience
• Organization into branches (illness, family,
old age, etc.) and into professional regimes
• Four regimes (that of salaried workers, the
public service, self-employed workers and
farmers)
• France has implemented important reforms
to social protection
• implementation of social security financing laws,
pension reform,
• creation of universal disease coverage
Conclusio
n • application of the social security regime for the
self-employed (RSI) that merges several funds
• pre-existing, etc.
• Government
• Complement
• Private Insurance
• Pocket Expense
◦ = Total Health Services Expense
Bibliograph
y•http://eurosocialsalud.eu/files/docs/00082.
pdf

• The health system in France.

http://med.unne.edu.ar/catedras/saludpub/
bparcial/005.pdf

•Zamora, Antonio. The role of the general

health insurance scheme in the financing of
health in France . October 2008.