Lecture Notes: French Healthcare System

Introduction

• Lecture by Dr. Dinka on the French Healthcare System.
• Focus on how France funds its healthcare, main features, and why it's considered the best globally.

Overview of the French Healthcare System

• Universal Healthcare: Financed by government national health insurance.
• Integrated into a broader social security system (includes retirement, unemployment benefits).
• World Health Organization (2000): Ranked France as providing the best overall healthcare.

Healthcare Expenditure

• 2017: France spent 11% of GDP on healthcare vs. 17% in the USA.
• Despite lower spending, France covers all legal residents, unlike the USA.

Structure and Coverage

• Universal coverage extended to all legal residents.
• 3.7% of hospital treatment costs reimbursed by private insurance.
• Healthcare provision managed nationally by the Ministry of Social Affairs, Health, and Women's Rights.
• Increasing state control over statutory health insurance (SHI) expenditures.

SHI Features

• SHI is divided into non-competing schemes based on occupation.
• Covers hospital costs, physician services, long-term care, and prescription drugs.
• Patients pay coinsurance, co-payments, and balance bills.

Historical Development

• 1945: Statutory health insurance for employees and retirees post-WWII.
• 1966: Extended to self-employed and unemployed.
• 2000: CMU (Universal Health Coverage) created for ineligible residents.
• 2016: Universal coverage granted under Puma Law.

Financing of SHI

• Payroll Taxes: Major funding source (53%), with employers paying 80%.
• National Income Tax: Contributes 34%.
• Tobacco & Alcohol Taxes: Additional funding, as these are considered health-impacting.
• Pharmaceuticals & Voluntary Insurance: Provide 12%.

Hospital Funding and Structure

• Public hospitals account for 65% of capacity.
• Private for-profit facilities: 25%.
• SHI reimburses hospitals under DRG system.

Accessibility and Coverage

• 12.7% reported unmet healthcare needs in 2019 (Eurostat).
• Freedom to choose doctors and no specialist referrals needed.
• Covered services include hospital care, outpatient services, maternity, pediatric, diagnostic, and prescription drugs.

Registration for Non-Residents

• After 3 months in France, you can register via local CPAM office.
• Required documents: ID, proof of residence, income proof, etc.
• Carte Vitale: Health insurance card needed for medical services.

Conclusion

• Dr. Dinka invites questions and comments via email.
• Appreciation for student participation and encouragement to stay engaged.