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After rising in the 1990s and the early years of this decade, France's spending on healthcare measured as a share of GDP has remained broadly stable in recent years. In 2009 France spent an estimated 11.4% of GDP on healthcare (four-fifths of which was public spending). This was higher than in any other EU country, but well below that in the US (16.3%). Around 80% of this was accounted for by public spending. The French health system is insurance-based. Statutory non-profitmaking health insurance funds, financed by employer and employee contributions, cover most of the population.
Reforms introduced in 2004 briefly succeeded in reversing the trend of rising deficits: after peaking at €11.9bn in 2004, the deficit in the health accounts of the régime général fell to €4.4bn in 2008. However, the savage economic downturn in 2009 has dented social security contributions. As a result, the healthcare deficit widened to €10bn in 2009. The French government expects that, in the absence of new measures, the deficit will rise to €15bn in 2010.
The high quality of France's healthcare system has come at a price. The deteriorating finances of the health accounts prompted the government to adopt an important (if still-modest and long-overdue) reform to the healthcare system in 2004. The aim was to curb the long-standing tendency of French patients to "over-consume" medical services, notably by reducing the incentives for patients to consult several doctors for the same ailment and increasing the cost to patients of extended stays in hospital. To this end, the reform established a central role for the family doctor (médecin traitant), usually a generalist, in taking initial consultations, directing patients (where necessary) to specialists and looking after medical files. The reform does not oblige patients to comply with the new system, but it penalises those who fail to do so, in the form of higher consultation fees with doctors and lower rates of reimbursement. Controversially, the reform introduced a non-reimbursable fee of €1 for medical consultations.
Further reforms to set the healthcare system on a more sustainable financial footing have been a priority since Nicolas Sarkozy was elected president in May 2007. The 2008 budget contained a series of measures to reduce the deficit, including an increase in the payments that patients must make out of their own pockets to cover part of the cost of prescription charges. Further measures were included in the 2009 budget, such as new rules promoting the use of generic drugs over more expensive branded products, and the introduction of a turnover tax for private supplementary health insurance funds. The most recent reform, the loi Bachelot, which was adopted in June 2009, provides for a radical transformation of the network of hospitals, ambulatory care and care services. A central plank will be the creation of new Agences régionales de santé (ARS), which will bring together all public bodies that are currently responsible for organising and financing healthcare at the regional level. The ARSs, which are expected to be established around mid-2010, will have responsibility for setting regional health objectives, co-ordinating services between different healthcare providers and distributing funding by signing contracts with individual hospitals.
French life expectancy is quite high by regional standards, but it would be even more so were it not for an unusually high mortality rate among the under-65s (particularly among men). Male life expectancy is adversely affected by high levels of alcohol and tobacco consumption and by a high incidence of fatal road accidents and HIV/AIDS. Government policy will therefore focus increasingly on preventative measures to reduce the incidence of "high-risk behaviour" that contributes to the unusually high rate of mortality among young French men. In 2003 the government cracked down on speeding and drink-driving, with some success: the measure has led to a sharp fall in the number of deaths on French roads since it was implemented. The government has also raised taxes on tobacco, which has helped to reduce the consumption of cigarettes. At the beginning of 2008, the government introduced a ban on smoking in public places and in 2009 it introduced a ban on all sales of alcohol and tobacco to people under the age of 18.
The findings of the Health of Nations Index are presented here, along with accompanying information and data on over 50 countries.
Start by scrolling around the map. Hovering over a country will reveal its index results. Click through to find the underlying data and other profile information. Use the tabbed filters above the map to browse by category filter.
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