France

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Health systems in transition
France
• direct state financing for certain services, for example sheltered workshops
(établissements et services d’aide par le travail) and adapted enterprises.
At the local level. The general councils (departments) also finance social
and health services for the disabled and contribute to the PCH.
Households. The OOP co-payment for care financed by SHI in residential
homes for disabled adults was €18 per day in 2010 (there is no OOP payment
for children). OOP payment for this type of care financed by general councils
varies across departments (however, it is estimated to be approximately the
same). Funders of each category of services are outlined in section 5.8.2 and
Tables 5.1 and 5.2.
Financing mental health care
Mental health care is provided by private practice health professionals, private
psychiatric hospitals or the public mental health care areas (soins de santé
mentale secteurs) (see section 5.11). Care provided for mental illness by GPs and
psychiatrists in private practice is covered by SHI at the usual rate. However,
people presenting an ALD-23 (long-term psychiatric condition) are fully
covered (see section 3.2). Care provided by psychotherapists or psychoanalysts
is fully financed by patients.
Care provided in public mental health care areas and in private psychiatric
hospitals for adults and children is financed by SHI. As in the general hospital
sector, patient co-payment (ticket modérateur) is 20% of a daily tariff that
varies across hospitals. The hospital flat-rate fee for accommodation is lower
than in the general hospital sector, at €13.5 per day in 2010 (see Table 3.8). Both
the patient co-payment and the hospital flat-rate fee for accommodation can be
fully covered by VHI.
People with mental disabilities also receive care and services from the health
and social care sector for the disabled (Tables 5.3 and 5.4 in section 5.11 list the
institutions that provide services for mentally ill patients); the financing sources
for these services are described above.
The expenditure on mental health services was estimated to be €16.6 billion
in 2007, divided into €13.4 billion for health care services (8.3% of total health
care expenditure on services and goods) and €3.2 billion for the health and
social health care sector for the disabled (Chevreul et al., 2013).