4. Health care financing and expenditure

4.1 Financing scheme

The financing of statutory health care in France differs from scheme to scheme. But those are minor differences. Generally, between 1946 and 1996 the financing of health insurance, depended predominantly on contributions from employees and employers. It was counted as a proportion of wages and salaries. Initially there should have been certain limits on those contributions. However, the financing scheme started its functioning without them.

By the year 1998 as a result of attempts to widen the social security system’s financial base, contributions based on earnings have fallen. Because of that fact a ‘general social contribution’ (CSG) based on total income was added to the contributions based on ernings. Nevertheless, while this change expanded the revenue base of health insurance funds, it did not increase the real amount of revenue collected.

After that the state interfered into HC financing actively. The parliament and the government began to develop financing policies and the controlling role of the state increased rapidly. Since that time the state monitors and regulates all HC financing coming from various contributions, taxes, compensations and other sources. (Green et al., 2001, p. 31-32)

4.2 Reimbursement

The general rule for reimbursement is that patients pay the health care provider by themselves and then claim reimbursement of their expenses from their health insurance fund. However, if the patient is hospitalised the hospital is paid directly by the health insurance fund.

In the book Health Care Systems in Transition: France Simone Sandier draws readers' attention to the following fact:

The reimbursement of health care costs accounts for 84.9% of statutory health insurance expenditure. Health care consumption is (usually partially) reimbursed through repayments to insured persons or payments to providers. The remaining 15.1% of statutory health insurance expenditure goes on cash benefits in the form of daily allowances paid to insured persons for maternity, illness or following an accident at work and disability pensions. (2004, p. 38)

In France there is a group of medical goods and services qualified for reimbursement. It includes the costs of hospital care and treatment in public or private hospitals and institutions, the costs of outpatient care provided by specialists, diagnostic services and care prescribed by doctors and etc. However, cosmetic surgery and most types of thermal cure are not included into this group as well as other services of uncertain effectiveness. And some, such as mammography for screening purposes, has limits on frequency with which they can be reimbursed.

Each type of medical good or service reimbursed by statutory health insurance has its own stated rate. This rate serves as the basis for calculating the total amount repayed to the patient, even if the prices actually charged were higher than the official rate. The patient’s contribution to the total cost of treatment varies according to the type of treatment and is higher for outpatient care and medicines than for hospital ones.

In certain situations health insurance fund may cover the total cost of treatment. There are three types of exemption: exemption due to the health status, exemption linked to the nature of the treatment provided, exemption linked to the person, usually concerns people involved in accidents.