The French Health Care System
The French health system runs on a unique set-up that has gradually evolved in the last hundred years. In 2000, the World Health organization ranked it as the number one health care system in the World.
The system works on the basic principle of national health insurance (NHI). Since 1928 this has increased to cover more and more sections of society dependant on profession, until 1974, a law proclaimed that NHI should be universal. Finally in 2000, coverage extended to cover the remaining uninsured population of France on the basis of French residency. There are 3 main NHI funds, with CNAMTS covering 84% of French residents:
- Caisse Nationale D’assurance Maladie des Travailleurs Salariés (CNAMTS)
- for salaried workers -
Mutalité Sociale Agricole (MSA)
- for farmers and agricultural workers - Caisse Nationale D’assurance Maladie des Professions Indépendantes (CANAM)
- for independant professions
NHI funds are private organisations but are responsible for the provision of a public service. They are supervised by the government which oversees social security. The insurance covers hospital care, outpatient services, prescription drugs, thermal cures in spas, and nursing home care. To a lesser extent, it also covers visual and dental care.
Charges for health care services provided are paid directly, followed by insurance claims to cover the cost. The charges are negotiated annually by health care representatives, the 3 main insurance funds and the state. Physicians must respect the amount they are able to charge, except those who have either chosen or earned the right to charge extra. The majority of these are in large cities, especially Paris. Here, the NHI will only cover the state-decided rate.
Exemption from direct payment for a health care service occurs when a) expenditures exceed approximately $100; 2) hospital stay exceed 30 days; 3) patients suffer from serious, chronic or debilitating illness; or 4) patient income is below a minimum rate.
The expenditures of the health care system are financed by taxes and a ‘general social contribution.’ Interestingly, taxes levied on alcohol and tobacco also contribute. In 2000, 9.5% of France’s GDP was spent on health.
Generally, out of total health care charges for one person, the NHI will fund 75.5%, other supplementary private insurance pay 12.4% and personal payments are 11.1%.
The French system has evolved into a provider of universal health care for the French population. Its financial set-up allows it to provide a high level of resources where it is neither criticised for rationing (like the NHS), nor for not covering all citizens (like the system in the United States). However, the system is not perfect. Prices are relatively low for physicians’ service and this has led to disputes between the physicians and the state. Other controls are being put into place which restrict the system, such as limits of the number of medical students who can pass through to year 2, controls on hospital beds and annual expenditure targets.
