France is more successful than most EU countries in shielding its population from financial hardship due to out-of-pocket healthcare expenses, though low-income households still face significant gaps in coverage, according to a new WHO/Europe report titled *“Can people afford to pay for health care? New evidence on financial protection in France.”* The report highlights that in 2017, only 2% of households (about 800,000 people) experienced catastrophic health spending, which occurs when healthcare costs prevent people from affording basic needs like food and housing.
However, for low-income households, this issue is much more severe. In 2017, 10% of households in the poorest fifth of the population faced catastrophic health spending, largely due to out-of-pocket payments for outpatient medicines and medical products such as hearing aids, glasses, and dentures. Unmet dental care needs, which are above the EU average, also disproportionately affect these households.
While France has made progress in improving financial protection, more can be done, especially for low-income individuals and those with chronic conditions. Dr. Natasha Azzopardi-Muscat, Director of WHO/Europe’s Division of Country Health Policies and Systems, emphasized the need for actions like exempting low-income households from co-payments and reducing balance billing to lessen financial hardship.
The report highlights three aspects of France’s healthcare system that help ensure affordability:
1. Universal coverage through the social health insurance (SHI) scheme, which is not dependent on contributions.
2. Exemptions from user charges for individuals with one of 32 chronic conditions, which account for 18% of the population.
3. Access to healthcare without user charges for undocumented migrants with low incomes after 90 days in France, through the state medical aid scheme (AME).
Despite these features, financial hardship remains for low-income households, due to the complexity of co-payments and limited dental care coverage. Complementary health insurance (CHI), which covers co-payments for around 95% of the population, is not a complete solution. It places a heavier burden on low-income households, who spend 6% of their budget on CHI premiums, compared to 2.5% for wealthier households. Financial and administrative barriers also limit access to CHI for many low-income individuals.
Since 2000, the French government has worked to strengthen financial protection through reforms, including the 100% Health (100% Santé) initiative, which was phased in between 2019 and 2021 to reduce balance billing for medical products such as dental, optical, and hearing aids. The report suggests further measures to improve access to affordable healthcare, including:
– Exempting low-income individuals and those with chronic conditions from all co-payments,
– Introducing an income-based cap on co-payments,
– Reducing administrative barriers to free or subsidized CHI, and
– Expanding dental care coverage and simplifying access to the AME scheme for undocumented migrants.
Damien Bricard, lead author from the Institute for Research and Information in Health Economics (IRDES), noted that while CHI access has increased, the poorest households are still the least likely to benefit from it, and even when they do, it often fails to provide sufficient protection, placing a heavy financial burden on them.
The report, produced in collaboration with IRDES, examines the extent of financial hardship related to healthcare in France between 2011 and 2024, using household budget surveys and other data sources.
