France

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Health systems in transition
France
• health and social care for elderly and disabled people financed by SHI
through the CNSA;
• expenditure related to the regional intervention funds (fonds d’intervention
régional); and
• other types of care, for example health care provided to French citizens
abroad, social and health care not financed through the CNSA and health
care networks.
Since the ONDAM target was introduced, priority has generally been given
to the health and social care sector over the health care sector (see Table 3.7).
From 1997 to 2003, there was significant spending in excess of the ONDAM.
To address this problem, a parliamentary Alert Committee was created in 2004.
If the system exceeds its projected budget by more than 1%, the Alert Committee
may ask the Directorate of Social Security (the watchdog for all social security
branches) to present a financial rescue plan. From 2003 to 2005, there was
a lower degree of overspending achieved through better control of spending
for ambulatory care and drugs. However, in 2006 overspending reached 1%,
and in 2007 the alert procedure was used for the first time, resulting in the
implementation of a range of cost-cutting measures in the fall of 2007. As a
result, overspending was more moderate in 2008 and further reduced in 2009,
despite the costs associated with two influenza epidemics: seasonal influenza
in early 2009 and the H1N1 influenza A at the end of 2009. Since 2010, the
ONDAM targets have been underspent (see Table 3.7).