France

Health systems in transition France 177
drugs, has not otherwise appeared to be a priority. However, following the 2012
National Strategy for Health goals, a new interministerial committee (Comité
interministériel de la santé), comprising all ministers as well as the secretary
of state for the budget, was created in June 2014 to ensure improvement in
population health and reduction of health inequalities through improved
coordination on all matters affecting health determinants (socioeconomic,
geographic, environmental, educational, etc.; see section 6.2).
7.2 Financial protection and equity in financing
7.2.1 Financial protection
Overall, financial protection of the French population is good. France is among
the OECD countries for which public financing of health care expenditure is the
highest and OOP spending is the lowest. In 2011, the Netherlands, the Czech
Republic, Japan, Denmark, Norway and Sweden were the only countries with
a higher share of publicly funded health expenditure. This is achieved through
a strong commitment by the French to their public SHI (93% of the French
population declare that the SHI system should remain publicly funded) and
the 1999 Universal Health Coverage Act, which provided universal health care
coverage for all people living in France (see section 3.2). In 2013, 77.4% of
personal health expenditure was publicly funded, with the remainder financed
by a combination of VHI (13.8%) and OOP payments (8.8%). Reduction of
financial barriers for groups at greatest financial risk was partly achieved
through the 1999 Universal Health Coverage Act by the provision of CMU-C
and through the implementation of the ACS, which provides means-tested
vouchers for VHI, thus reducing exposure to OOP expenditure (see section 3.3).
However, the proportion of the population covered by complementary health
insurance does not fully reflect the degree to which financial risk is covered.
Indeed, there are large discrepancies within the covered population in terms
of the cost of contracts and level of coverage (see section 7.2.2). While 94%
of the population had complementary health insurance in 2012 (either VHI or
CMU-C), among those covered by VHI, 70% say that hospitalization is well
covered by their contracts, as opposed to vision correction (52%), extra-billing
by specialists (48.5%) and dental prosthetics (46.4%) (Célant, Guillaume &
Rochereau, 2014).