Zooming in on French Healthcare

Over the last five years, French healthcare has seen some progress, especially with the democratization of e-health during the Covid-19 crisis. However, the pandemic served to reveal a number of weaknesses in the healthcare system, starting with the most prominent health issues of the population to the siloed modes of operation between practitioners. Laure Millet, Head of our Healthcare Policy Program and Emma Ros, Policy Officer at our Healthcare Policy Program, explore how French healthcare has fared and evolved during this presidential term. 

With only three months to go until the French elections, this article is part of a series that looks into the achievements and drawbacks of Emanuel Macron’s presidential term. The extended analysis in French can be found here. 

Key Notions: 

Where does healthcare take place? 

• Hospitals - hospitals can be public, non-profit or private. They provide care for medical emergencies, surgeries etc. 
   
• Médecine de ville - literally known as "city care" in France, includes both general practitioners and specialized medicine and is composed of individuals or groups of physicians practicing in their own private clinics. These also include community health centers, known as maisons de santé. 
   
• Medico-social care - the domain of French healthcare that aims to accompany patients beyond immediate ambulatory care and to include social services. This domain focuses on people with disabilities, the elderly or any other individuals in a situation of social exclusion and precarity.. 

Who does one receive healthcare from? 

• In France, patients are free to choose their own general practitioner, specialized doctor or healthcare center, both from the public and private sector. However, each of these structures operates in silos, giving rise to various coordination problems. 

What does health insurance look like in France? 

• Assurance maladie - health insurance is a part of French Social Security. The government covers expenses for treatment and allowances related to sickness, maternity, disability, death or accidents at work. Health professionals and the Social Security have agreed on a conventional tariff rate that the patient should be charged, which determines the amount of reimbursement you can receive through public health insurance. Health professionals are then free to charge beyond this conventional tariff: anything exceeding that rate is left at the patient’s own expense, or covered by private insurance. As per the principle of universal health coverage, any person who works and resides in France is entitled to having their healthcare covered.
   
• Complémentaire de Santé - colloquially known as mutuelle, this is a complementary health insurance provided by insurance companies, which can cover the additional expenses not covered by the basic compulsory plan of the state health insurance. Signing up for complementary insurance is optional, however if you are a private sector employee, your employer is obliged to provide complementary insurance for you. 

How is the healthcare budget allocated?

• France spends over 11% of its GDP on healthcare. However, only 2% of that goes into prevention. Household health expenditures are among the lowest in the OECD countries, mounting up to around 2% of household consumption, compared to an average of 3.3% in other OECD countries. 
   
• The Social Security Financing Bill (PLFSS / Projet de loi de financement de la Sécurité sociale) - Every year the government presents a PLFSS bill, aimed at determining and controlling health and social care spending for the year. 

Key Figures: 

1. France allocates 11.2% of its total GDP to healthcare. By way of comparison, the UK spends 10.2% of its GDP on healthcare, Sweden and Germany 11% and the US 16.8%. 
    
2. 2% of final household consumption in France is spent on health.This is amongst the lowest spending recorded in OECD countries, well under the 3.1% mean, and lower than that spent in the UK (2.6%), Germany (2.9%) and Italy (3.6%). 
    
3. 2 million people, or 7% of the population are employed in the healthcare sector. 
    
4. The private sector invests an estimated €4 billion euros in healthcare, while the public sector invests around €4.5 billion. It is one of the few sectors to benefit from significant investments in R&D. 

Evaluating healthcare during the Macron presidency

The French healthcare system had been in crisis well before Covid-19. The pandemic revealed many existing challenges, especially in the emergency services. There are several key takeaways from the Macron’s five-year term in healthcare: 

• The Ségur de la santé (named after the avenue where the Health Ministry is) refers to a council held between the government and various actors of the French healthcare system that took place during the summer of 2020, in response to the health crisis. This series of consultations led to the signing of the Ségur agreements, which are due to allocate €19.3 billion to hospitals and nursing homes. The Ségur also includes a €2 billion investment in health information systems, in order to improve interoperability and optimize the collection and analysis of health data.
   
• Telemedicine has experienced an unprecedented boom in the past two years since the beginning of the Covid-19 crisis. Between February 2020 and February 2021, the number of remote consultations grew by 40. This is in part explained by the fact that these became fully refundable by the social security system in March 2020. In March 2021, 71% of the French reported having used an online platform to book their medical appointments. 
   
• An online health portal, known as Mon Espace Santé ("My Health Space") is set to be launched in 2022. Its purpose is to centralize all of a patient’s medical data, to provide secure messaging between patients and health professionals and to serve as a catalog for digital health services. However, that would require extensive digital training for both health professionals and patients, given that 17% of the French population is currently digitally illiterate. 
   
• The pandemic has highlighted the need for government support for medical innovation, a shortfall recently made obvious by France's lack of a Covid-19 vaccine development. To that end, the Strategic Council for Health Industries (CSIS) has allocated a budget of €7 billion to enable France to boost its innovation and medical autonomy. Priority has been given to cutting edge advancements such as 5P Medicine, e-health and biotherapy. To facilitate innovation in the healthcare sector, the government has also created the Health Innovation Agency. 
   
• Psychiatry in France has been in a major crisis for years, due in part to a significant lack of means and personnel. Covid-19 revealed the extent of this crisis and drove some changes, but much still remains to be done to improve patient care. To that end, general practitioners and primary care providers need to be given a greater role and more agency in the early detection and treatment of psychological disorders. 
   
• There is significant need for improvement in the collection, management and coordination of health data. The development and implementation of a Health Data Hub aims to address this need in a clear, transparent and ethical way in order to support and promote innovation. Such an incentive is particularly relevant to prevention in the fields of healthy aging and loss of autonomy, providing patients with personalized and proactive treatments.
   
• Human capital and the training of healthcare professionals must become a priority for public authorities. Investment and innovation should target the development of new healthcare professions, reducing silos, a better delegation of tasks, training in digital technology and management, etc.
   
• As revealed by a recent survey, 8 out of 10 French people feel that the topic of healthcare is not sufficiently being taken into account by the campaigns of the presidential candidates. With only a few months to go until the elections, we can not afford delaying the discussion on the future of healthcare and how it is managed.