France

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Health systems in transition
France
Pharmaceuticals. Most drugs are covered at a rate of 65%, but this ranges
from 100% for non-substitutable or expensive drugs to 15% for drugs judged to
have a low SMR. Extra-billing for prescription drugs is not allowed and thus
the market price is the same as the SHI statutory tariff.
Medical devices. Medical devices and prostheses are subject to various
coverage rates depending on the medical device. The reimbursement rate is
defined by reference to the statutory tariff, but manufacturers and distributors
are free to set a price in excess of this tariff. In certain cases (e.g. spectacles,
dentures, hearing aids), the reimbursement levels are particularly low.
Full coverage for defined categories of patients
As noted above, certain hospitalizations are covered for 100% of the
statutory tariffs. Exemptions from co-insurance for all types of care apply in
certain circumstances:
• exemptions linked to health status, including individuals covered by
the ALD programme for treatment related to the condition;
• exemptions linked to the nature of the treatment provided, such as abortion
and infertility treatments (AME beneficiaries are not covered for infertility);
and
• exemptions linked to the person concerned, such as those involved in
accidents at work, pregnant women after the fifth month of pregnancy,
contraceptives for minors aged 15 or more, live organ donors,
disabled children and pensioners.
Exemptions on economic grounds do not exist. However, the free public
complementary VHI coverage for people with low incomes (CMU-C; see
section 3.5.1) effectively provides full coverage on an economic basis.
Deductibles for regular goods and services
In order to raise additional revenue for SHI, flat-rate deductibles 2 were
introduced in 2005: €1 (participation forfaitaire) is charged for every physician
visit, laboratory test and diagnostic imaging up to an annual limit of €50. The
list of goods and services to which deductibles (franchise médicale) apply was
expanded in 2008 to include drugs (€0.5 per package), ancillary care (€0.5 per
service up to a daily limit of €2) and medical transportation (€2 per transport
up to a daily limit of €4). A second annual ceiling of €50 is set for these types
2
Technically, the term “deductible” usually refers to a fixed amount that is required to be paid by a patient before
a third-party payer will begin to reimburse for services. However, in France, the term is used to describe the
amount that is deducted from the tariff covered by SHI. For example, if €20 is paid by the patient to the health care
professional and the patient sends his/her claim for reimbursement to SHI, first the amount covered is calculated:
for example, 70% of the total cost (70% of €20 is €14). Then the “deductible” is taken from this amount (€1, for
example). Finally, €13 in total is reimbursed to the patient.