France’s healthcare system is often considered one of the most comprehensive in the world: the taxpayer funded system provides nearly universal coverage for all citizens, regardless of income or age, while also allowing citizens to choose their primary care provider. The system is largely regarded as one of the world’s best, although recent increased demand due to an aging population, along with larger economic issues, have begun to strain the typically solvent healthcare system. As such, reimbursement levels for non-essential care have recently been reduced. Nevertheless, the system is still considered to be effective in regard to the totality of coverage provided.
The payer system in the French healthcare system is levied primarily through salaries paid by all employees, or through taxes for the self-employed (Mossialos et al., 2016). These costs are automatically deducted from one’s paycheck. In addition to receiving funding from employment wages, there are minimal payments associated with healthcare provider visits. Patients register with a general practitioner of their choosing; while they are free to consult with any other physician, only the general practitioner with whom they are registered can authorize a visit to a specialist.
All visits include a flat rate payment, which is currently 23 Euros per visit, although slightly higher costs may be assessed for more complex treatments, such as surgery (Mossialos et al., 2016). However, these costs are largely reimbursed by a government-run health insurance provider, so the total cost of expense per visit is reduced even further, averaging between 0 and 6 Euros per visit (Mossialos et al., 2016). Thus, financing for the French healthcare system is a mandated expense for all employed citizens via taxation, but the cost per visit amount is extremely low and designed to be both accessible and affordable for all citizens.
For specialist care, citizens are reimbursed if the specialist was referred directly by their primary general practitioner. If another specialist is chosen, only a minimal amount will be reimbursed. However, as long as citizens seek specialist care that has been recommended, these services are also either drastically reduced or free.
Pharmacy services also follow the general practitioner model, although instead of receiving a reimbursement, prices are often reduced at the point of sale. The discounted price on pharmaceuticals depends on whether the medicine is considered essential, with four different levels of discounts: 100%, or no cost; 65%, which is the average rate; 35%, for non-essential medicines; or no discount for medicines, including alternative treatments, that have not been clearly identified to provide results (Finnerty et al., 2016).
France has both state-run and private hospitals, although private hospitals are generally still approved by the state and can provide the same levels of reimbursement as a state run hospital. The decision on whether to receive services from a state-run or private hospital is therefore largely determined by whichever one the recommended specialist is currently employed with. As such, most patients do not consider whether the hospital they are visiting is state-run or private, as the quality of service and cost between the two are considered relatively equal.
While France’s healthcare system is designed to provide holistic and comprehensive coverage, with drastically reduced costs to the individual patient at the time of visit, recent economic strain throughout Europe, along with a rapidly growing elderly population has begun to increase demand on the availability of services (Devaux, 2015). As such, France has increased the cap number for medical students in recent years to bolster the number of general practitioners. Additionally, there have been slight reductions in the amount of reimbursements paid for non-essential services, including dental care, although the total cost of care for these services is still among the cheapest in the world.
- Devaux, M. (2015). Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. The European Journal of Health Economics, 16(1), 21-33.
- Finnerty, B. M., Brunaud, L., Mirallie, E., McIntyre, C., Aronova, A., Fahey, T. J., & Zarnegar, R. (2016). Cost disparity between health care systems in the United States and France. Surgery, 159(1), 132-141.
- Mossialos, E., Wenzl, M., Osborn, R., & Anderson, C. (2016). 2015 International Profiles of Health Care Systems. The Commonwealth Fund.