France

Health systems in transition France 29
been considered too independent in terms of defining its work programme
and, therefore, not responding appropriately to the need of the government
and the state for more guidance concerning the efficiency of the system. The
planned 2015 Health Reform Law (see section 6.2) is, therefore, considering a
change in the strategic governance of HAS to ensure that it will respond more
appropriately to public needs.
2.3.5 SHI
SHI is composed of several schemes, which cover virtually the entire population.
Individuals and their families are affiliated with a scheme based on their
employment status and remain in this scheme in retirement. Working people
have no choice regarding the scheme in which they are enrolled and may not
opt out of coverage except in certain cases (e.g. expatriates and employees of
international corporations or institutions). Consequently, there is no competition
among the schemes. Non-working people are automatically enrolled in the
general scheme.
The three main schemes and beneficiaries in 2011 are as follows:
The general SHI scheme (Caisse nationale d’assurance maladie des
travailleurs salariés; CNAMTS) covers employees in commerce and industry
and their families (57 million beneficiaries accounting for 88% of the population)
and individuals eligible for CMU basic coverage (2.2 million beneficiaries,
3.4% of the population).
The agricultural SHI fund (Mutualité Sociale Agricole) covers farmers and
agricultural employees and their families (3.4 million beneficiaries, 5.1% of
the population).
The SHI scheme for self-employed people (régime social des independents)
covers artisans and self-employed people (with the exception of self-employed
agricultural workers), including professionals such as lawyers and independent
health professionals (4 million beneficiaries, 6% of the population).
The schemes are represented by the National Union of Health Insurance
Funds (Union Nationale des Caisses d’Assurance Maladie; UNCAM) in
negotiations with health care providers.
Each of the three major health insurance schemes is made up of a national
health insurance fund and local structures corresponding to the degree of
geographical distribution involved.