Chapter 2

2.1 - Deficit containment or costcontainment?
The politics of health care
expenditures in France
de Pouvourville G. 1
Like many other comparable developed countries, French governments have been struggling
for the past 30 years to contain health expenditures growth rate to a sustainable
level, considering the growth rate of the economy. If the goal of public policies has always
been to achieve a balance between resources and expenditures, GDP growth and health
care expenditures, then they have permanently failed. The share of overall National
Health Expenditures in the GDP was of 8,1% in 1980, 9,3% in 1990, 9,91% in 2000 and
11,14% in 2005. Thus, expenditures have always been growing faster than the national
wealth. Since 1997, the Parliament sets every year an official rate of increase for Sickness
Fund Expenditures. In 1997, expenditures increased 1,5% whereas the objective was
1,7%. Since then, expenditures have been increasing on average 1,7 times as fast as the
objective, with a high of 2,6 times in 1999. As a consequence, the deficits of the General
Sickness Fund, which covers 90% of the population, are quasi-permanent (see Figure 1).
Figure 1 - National Sickness Fund-Annual Balance - Millions of €
3000
2000
1000
0
-1000
-2000
-3000
-4000
-5000
-6000
-7000
-8000
-9000
1980 1985 1990 1995 2000 2005
National Sickness Fund-Annual Balance Millions of €
1 Senior Research Director INSERM/CNRS, France.
Eco- Santé 2006
[119]
CEIS Health Report 2006