France

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Health systems in transition
France
complementary universal health coverage (couverture maladie universelle
complémentaire; CMU-C) has been offered to those on lower incomes; it covers
7% of the population.
Even after complementary insurance, out-of-pocket (OOP; reste à
charge) payments from patients themselves account for 7.5% of total health
expenditure. This raises issues of equity in access and financing, although this
figure remains well below the EU average for OOP payments of 16.1% of total
health expenditure.
Funding for long-term care (soins de longue durée) for the elderly and
disabled is partly provided by a dedicated fund, the National Solidarity Fund
for Autonomy (Caisse Nationale de Solidarité pour l’Autonomie; CNSA). This
was created in 2004 following a heat-wave crisis in the summer of 2003 in
which around 15 000 elderly people died. Its resources come from SHI and
the “solidarity and autonomy contribution” (contribution solidarité pour
l’autonomie) that is generated from the revenue equivalent to one unpaid
working day (journeé de solidarité). Local authorities increasingly also fund
long-term care, as do individuals themselves.
Hospital acute care and hospitalization at home (hospitalisation à domicile;
HAD), providing care equivalent to hospital care but in the patient’s own home,
are paid by a diagnosis-related group (DRG; groupe homogène de malades)
method under the medical activity-based payment system (tarification à
l’activité; T2A). Self-employed professionals are paid on a FFS basis. Tariffs
are negotiated between SHI and representatives of health professionals and
approved by the Ministry in charge of Health, although extra-billing by
doctors above that tariff is allowed in some cases. Pay-for-performance (P4P;
rémunération à la performance) financial incentives to improve quality and
efficiency of doctors’ practices were implemented through individual contracts
with general practitioners (GPs; médecin généraliste ou omnipraticien).
Physical and human resources
Non-profit-making hospitals make up 61% of the total (35% public and 26%
private sector) and 39% were private hospitals operated on a profit-making basis,
a higher share of profit-making hospitals than in most other developed health
systems. Two nationwide capital investment plans have been launched since
the early 2000s in order to improve quality and safety standards. In December
2013, the French Government also signed an agreement with the European