FRANCE | Summary


GDP: 2.716 Trillion USD1
Health Expenditure (% of GDP): 11.31%2
  • Population: 65.3 Million
  • Housing: 81.5% Urban, 18.5% Rural


France reached universal health coverage through various reforms and improvements to the health system. It progressively covered different populations and expanded coverage until reaching universal coverage. Prior to the Second World War, France provided health care through Mutual Benefit Associations. It became statutory for employers to provide health care coverage with the 1930 Act of Social Insurance; coverage included illness, maternity, ageing, and death. Health Systems in Transition states that, "By 1939, two-thirds of the French population was covered for illness by mutual benefit associations, with free choice of the organization providing coverage."6
In 1945, following the end of World War II, the health care system in France was reformed. The Social Security insurance (SHI; assurance maladie) system, still in place today, introduced a new system of health care financing and pensions. Initially, coverage was only extended to workers but then expanded to more populations: employees (in 1945), retirees (in 1945), the self-employed (in 1966), and the unemployed (in 2000).6 Universal Health Coverage (Couverture Maladie Universelle or CMU) was launched in 2000 to protect those not covered under the SHI. This left 1% of the population not covered with any baseline health care.7
In 2016, according to The Commonwealth Fund, SHI eligibility was made universal under the Protection universelle maladie (Universal Health Protection law, or PUMa). This health care access to all residents in France as well as foreigners. It merged coverage for persons previously covered by the Universal Health Coverage and immigrants covered by the state-sponsored health insurance.6


France has universal health care because of the expansion of SHI. Its health care system is a blend between the Bismarck and Beveridge model. It is Bismarckian in its centralized character with the national government; it is Beveridge with its strong role of the state. The provision and management of the health care system is a responsibility at the national level; the Ministry of Social Affairs, Health, and Women’s Rights set the agenda. However, the state has increasingly been involved in controlling the expenditure of the statutory health insurance (SHI).6 
The SHI covers the entire population, and, according to The Commonwealth Fund. The SHI is is broken up into schemes, each of which do not compete with each other and cover a different portion of the population based on occupation. SHI covers most costs for hospitals, physicians, and long-term cares, and prescription drugs. Patients are responsible for coinsurance, copayments, and balance bills for physician charges that exceed covered fees.According to Health Systems in Transition, the delivery of health care is mixed, and includes, "private, fee-for-service (FFS; rémunération à l’acte) physicians, public hospitals, private non-profit hospitals and private profit-making hospitals."5 
Filling in the gaps of the SHI is voluntary health insurance (VHI). VHI is a private, complementary health insurance which French citizens can access. About 90% of the population has this insurance, mainly through their employer. The VHI is set to cover benefits not covered by the SHI, such as copayments and balance billing. Low-income individuals are entitled to free or state-sponsored VHI which includes free vision and dental. Complementary insurance is provided mainly by not-for-profit, employment-based associations. Private for-profit companies offer both supplementary and complementary health insurances.6
SHI is financed 77% publically. According to The Commonwealth Fund, the breakdown is as follows6:
  • Payroll taxes provide 53% of funding, with employers paying 80% of the tax and employees paying the rest; contributions are calculated from the actual salaries, capped at EUR 3,311 (USD 4,191) per month;
  • National earmarked income tax contributes 34% of funding;
  • Taxes levied on tobacco and alcohol, the pharmaceutical industry, and VHI companies provide 12 percent of funding; and
  • State subsidies account for 1 percent of funding. 


  • Fertility Rate: 1.85 live births per woman  
  • Life Expectancy (Female, Male): 86, 83  
  • Infant Mortality Rate: 2.7 deaths per 1,000 live births  
  • Child Mortality Rate: 3.2 per 1,000 live births
  • Maternal Mortality Rate: 8 deaths per 100,000 live births  
  • Prevalence of Obesity: 17%
  • White: 85% (77% French)
  • North African: 10% (mainly Maghreb region)   
  • Black: 3.3%
  • Asian: <2% 
  • 0-14 years: 18.5% 
  • 15-24 years: 11.8%  
  • 25-54 years: 37.5% 
  • 55-64 years: 12.4%  
  • 65 years and over: 19.8%


1 France. The World Bank. (2020).

2 The World Bank. (2017). Current health expenditure (% of GDP). Data.

3 France Population (LIVE). Worldometer. (2020).

4 Huet, N. (2015, December 17). French health law promises free doctor visits. Retrieved from

5 France: Health System Review. (2015). Health Systems in Transition, 17(3).

6 Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. `, &amp; Wharton, G. A. (2020, June 5). France. The Commonwealth Fund.

7 Sawe, B. E. (2019). (rep.). WorldAtlas. Retrieved from 

8 France Age structure. France Age structure - Demographics. (2020).

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