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70 Health systems in transition France Fig. 3.7 Financial flows in the health care system (excluding long-term care and prevention) Firms Voluntary contributions Voluntary contributions Complementary health insurance Private: 90% of population Public: 7% of population Compulsory contributions & taxes Taxes (CRDS) Subsidies Taxes Agency for Funding Social Security Debt Taxes CMU Fund Central Social Security Agency (ACOSS) Social contribution & subsidies Allocation based on patient share Subsidies Statutory health insurance (SHI) (99% of population; 74% of expenditure) Compulsory contributions & taxes (mainly “CSG”) Taxes Taxes Ministry in charge of Health, central and local governments (free for the poor) Municipal health centres Salaries Population Fixed rate co-insurance & other OOP Private ambulatory physicians Public hospitals FFS rates based on contracts: adjusted variable rates FFS rates P4P, capitation DRG – based prospective payments + additional budgets FFS rates Non-profit-making private hospitals DRG – based prospective payments + additional budgets FFS rates DRG – based prospective payments Patients Private hospitals & clinics FFS rates Pharmacists FFS on fixed prices P4P, capitation Private allied health professionals FFS on prescription by doctor Cash transfers Financial flows Transfer flows Services flows Source: data updated from Chevreul et al., (2010). Note: CRDS: Social debt repayment contribution.
Health systems in transition France 71 3.3 Overview of the statutory financing system 3.3.1 Coverage Breadth of coverage French SHI provides nearly universal coverage, with 99.9% of the population covered in 2013 (see section 2.3.5). Individuals are generally covered on an employment basis, and any dependants of the insured person are also covered. Employees cannot opt-out. For those not covered through one of the obligatory SHI schemes on an employment basis, the CMU Act offers SHI coverage to individuals who legitimately reside in France. CMU coverage is free for individuals with household revenues up to an established ceiling (€9534 in 2013–2014); other beneficiaries must pay an annual premium equal to 8% of revenues above the ceiling. Thus, coverage criteria have progressively moved from an employment basis to residency status. For transitory foreigners and undocumented migrants who have resided in France for at least three months, the AME provides free access to medical care for those with revenues below the CMU ceiling. Prisoners and their families are systematically covered by the SHI general scheme for the duration of the imprisonment. Scope of coverage Medical goods and services covered by SHI include: • hospital care and treatment in public or private institutions providing health care, rehabilitation or physiotherapy; • outpatient care provided by GPs, specialists, dentists and midwives; • diagnostic services and care prescribed by doctors and carried out by laboratories and paramedical professionals (nurses, physiotherapists, speech therapists, etc.); • pharmaceutical products, medical appliances and prostheses prescribed and included in the positive lists of products eligible for reimbursement; and • prescribed health care-related transport. In order to be eligible for coverage, diagnostic services, treatment, drugs and prostheses must be provided or prescribed by a doctor, a dentist or a midwife and dispensed by health care professionals or institutions recognized by SHI.
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Contents Contents Preface
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Preface Preface The Health Systems
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Acknowledgements Acknowledgements T
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List of tables, figures and boxes L
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Abstract Abstract This analysis of
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1. Introduction 1. Introduction The
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6. Principal health care reforms 6.
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7. Assessment of the health system
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8. Conclusions 8. Conclusions In Fr
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