Current population in France is about 62 million. If overseas territories are included, the entire population is about 64 million. Average income per capita is US$36,550. Top income tax rate is a little over 48 percent.
Under the law of universal coverage called la Couverture maladie universelle, The French government provides mostly free health insurance through its Social Security Program (Sécurité sociale). About 96% of French people are covered under the system. Private insurance provides supplemental coverage; more than 85 percent of the people have supplemental insurance, often through their employers.
The French healthcare system has been in place for over 60 years, and has continued to evolve. The World Health Organization (WHO) classified it the "best health system in the world" in its June 2000 Worldwide health systems comparison report.
Coverage
The Sécurité Sociale universal health insurance covers for all or part of the healthcare needs: hospitalization, doctor visit, preventive care, prescription drugs & medical equipment, emergency care & medical evacuation, dental & vision. However, the plan covers about 70% of actual medical fees. Prescriptions are only reimbursed from 35% to 65%. Treatment costs for long-term illnesses are fully reimbursed. There is compensation in the case of pregnancy.
In addition, supplemental health Insurance plans, generally referred to as a "Top-Up" policy or assurance complémentaire, sold by private insurance companies, are in place to complement the Social Security's coverage. There are a wide variety of providers offering an extensive range of plans and premium schedules to meet individual circumstances.
Funding
Most of the funds come from social security taxes on salary and income. Employers pay 12.8% on employees' total gross salary, while employee adds in 0.75%. Another tax called General Social Contribution (CSG) introduced in 1991 helps to reduce shortfalls. It is 7.5%, calculated from 95% of the gross salary. The CSG is inclusive all income, as well as the income of capital and property. Taxes on alcohol and tobacco also contribute to the overall funding.
Actual budget varies according to revenue earned through taxes each year. But rising costs has caused the system running constant deficits since 1985, which has ballooned to over $14 billion and continues to grow. In 2004, French people spend $3,500 Per-capita on health care. That's around 10.7% of their GDP.
The French system is often categorized as a mixed system in which public and private provision and funding co-exist. Private health insurance is more important in France than in any other European countries.
Delivery
There are two large organizations that work under the Ministry of Health: General Health Management and Hospital & Healthcare Management, under which there are three types of health care facilities and agencies, which are public hospitals, private clinics and not-for-profit healthcare centers.
There are 1,032 hospitals under the public hospital statute. Regional, university, local and general hospitals are included in this category. There are 2,139 private for profit and not-for-profit healthcare facilities actively treating more than 50% of surgeries and more than 60% of cancer cases. In all hospitals, doctors, biologists, and dentists are all paid as "hospital practitioners." This combination of public and private medical services produces a health care system that is open to all and provides the latest in medical technology. Waiting lists for surgeries found in other socialized healthcare systems do not exist in France.
Medical treatments from a routine visit to a GP to major surgical procedures have a tarif (cost). Medical practitioners, hospitals & clinics that adhere to this tarif are defined as conventioné; those that do not are defined as non-conventioné and can charge more. Vast majority of practitioners (around 97%) are conventioné, and even a private clinic can be conventioné. Treatments, whether private or public, is not free at the point of delivery. Patients first pay the full bill (tarif) and are then reimbursed later (about 10 days). Generally speaking, Sécurité sociale refunds 70 per cent of the cost of a visit to a médecin traitant (a GP or family doctor) and most specialistes.
Performance
This is the one socialized medicine system which does not have the same problems as the rest have. Good cooperation between the public and private sectors and sufficient availability of providers allow citizens to avoid waiting lists for diagnosis, surgeries and treatment. Over 65% of the people express satisfaction with their system.
People can choose among healthcare providers, regardless of their income level. They can consult a variety of doctors and specialists or choose a public, private, university or general hospital.
Current life expectancy in France is 80.7, with French women having the second highest life expectancy in the world. The World Health Organization (WHO) classified the French system the "best health system in the world" in June 2000.
Deficiency
Even the best health care system in the world has its own set of problems. Because of the high level of reimbursement and coverage, French health care is among the most expensive in the world. Its budget is the world's third largest, accounting for 11% of GNP. Rising costs and aging population make it a struggle for France to finance this system. If spending continues at the current rate, the health service may be 70 billion Euros in debt by the end of 2020.
Waste is another problem within the system. Sources suggest that patients "shop" for doctors, visiting multiple specialists until they receive the diagnosis they want. One fifth of the country's health spending goes to pharmaceuticals due to overuse of prescription drugs.
Doctors Without Borders organization estimates that over 300,000 people in France are now without health-care coverage under a universal health care system.
Reform
French reformers' first priority is to move health insurance financing away from payroll and wage levies because they hamper employers' willingness to hire. Instead, France is turning toward broad taxes on earned and unearned income alike to pay for health care.
The debates on how to balance the budget and avoid deficits have been ongoing without acceptable solutions.
Efforts by the administration to control costs by cutting overly rich benefits and by managing waste have met stiff resistance.
