France

14
Health systems in transition
France
The French trends in improving health status, as reflected by the increase
in life expectancy and the decrease in infant mortality, have not been equally
beneficial across socioeconomic groups, with the greatest improvement
being observed among the wealthiest. For example, life expectancy at 35 is
seven years lower for working class men and three years lower for working
class women compared with managers (Danet, 2012). These inequalities also
exist when morbidities or risk factors such as obesity are examined (Table 1.6).
Table 1.6
Social inequalities in health and access to care between workers and managers
in France, 2010
Average number
diseases declared
Obesity (%
population)
Dental problems
(% population)
Access to dental
care in the last
2 years
(% population) a
Workers 2.9 15.2 44.0 63.9
Managers 2.5 6.3 29.4 82.3
Sources: Dourgnon, Guillaume & Rochereau, 2012; Clavet, Moisy & Chardon, 2013; OECD, 2013.
Note: a 2009 data.
These social health inequalities result not only from risk factors such as
alcohol and tobacco consumption but also from differences in access to health
care that seem to increase over time. In 2012, 26% of the population reported
having forgone health care in the last 12 months for financial reasons (Célant,
Guillaume & Rochereau, 2014). This inequity in access is concentrated in a
limited number of goods and services for which OOP expenditure by patients is
the highest. Dental health care is of great concern (18% of the population aged
18–64 years have forgone dental health care in the last 12 months), followed
by eye care (10%) (Célant, Guillaume & Rochereau, 2014). Forgoing health
care increases inversely with the level of income: people in the lowest income
quintile (under €926 a month) are nearly three times more likely to forgo care
than people in the highest income quintile (more than €2120 a month) (Célant,
Guillaume & Rochereau, 2014).
Recent immigrants have lower health status than individuals who were
born in France. This is partly explained by lower socioeconomic status, lower
complementary VHI coverage and by the economic level of the country of
origin. Immigrants also have lower access to health care, with greater barriers
for specialist visits than for visits to GPs (Berchet & Jusot, 2011, 2012). Several