[et_pb_section fb_built=”1″ _builder_version=”4.21.0″ _module_preset=”default” background_color=”#dce5ea” custom_margin=”||||false|false” custom_padding=”30px|15px|0px|15px|false|false” global_colors_info=”{}”][et_pb_row _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||2em||false|false” global_colors_info=”{}”]<\/p>\n
The P4H Network and the French National School for Social Security [\u00c9<\/u>cole <\/u>n<\/u>ationale <\/u>s<\/u>up\u00e9rieur<\/u>e<\/u> de S\u00e9curit\u00e9 <\/u>s<\/u>ociale<\/u><\/a>] (EN3S)\u00a0have been collaborating to document and share knowledge about France\u2019s SHP system\u00a0and experience in SHP. France\u2019s experience in social health protection (SHP) is one of the richest in the world. The results are noteworthy<\/u><\/a>.<\/p>\n This page invites visitors to view four slides<\/strong>, located at the top of the page. <\/strong>They illustrate the health care ecosystem in France.\u00a0The slides\u00a0summarize health\u00a0care provision, the social health insurance system, and the stewardship of financial risk coverage.<\/p>\n Below the slides, viewers can click on <\/strong>three<\/strong>\u00a0<\/strong>timelines<\/strong> detailing the history of SHP from the perspective of stakeholders on progress in universal health coverage and changes in health insurance financing.<\/p>\n Below the timelines, readers will find <\/strong>five briefs <\/strong>in French\u00a0<\/strong>on aspects of SHP in France.<\/p>\n Timely articles from EN3S\u2019s newsletter, S\u00e9cu<\/em>\u00a0Hebd<\/em>o<\/em>, further enrich this page.<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ disabled_on=”off|off|off” admin_label=”section” _builder_version=”4.21.0″ custom_margin=”0px||||false|false” global_colors_info=”{}”][et_pb_row admin_label=”row” _builder_version=”4.21.0″ background_color=”RGBA(255,255,255,0)” background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”0px|0px||0px|false|false” custom_padding=”0px|15px|0px|15px|false|false” collapsed=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_slider show_pagination=”off” arrows_custom_color=”#7a9db0″ module_class=”p4h-slider” _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”0px|0px|20px|0px|false|false” custom_padding=”0px|0px|0px|0px|false|false” hover_transition_speed_curve=”ease-in-out” hover_enabled=”0″ custom_css_slide_description=”animation-name: none;” global_colors_info=”{}” animation_style=”slide” sticky_enabled=”0″][et_pb_slide heading=”The individual is at the heart of the system” image=”https:\/\/p4h.world\/app\/uploads\/2023\/01\/2023_05_02_diagramme_France_EN3S_.pptx-copy.png” _builder_version=”4.21.0″ _module_preset=”default” header_text_color=”#EA3A32″ body_text_color=”#2D424C” background_color=”#FFFFFF” background_enable_color=”on” text_orientation=”left” custom_padding=”0px|0px|0px|0px|false|false” hover_enabled=”0″ custom_css_slide_image=”margin-bottom: 30px !important;” global_colors_info=”{}” sticky_transition=”on” sticky_enabled=”0″]<\/p>\n The patient must reside in France (French nationality or not, but legally resident in the country). As such, they are insured.<\/p>\n If the patient is of French nationality but not resident in France (expatriate or frontier worker), then the European Union regulation on the coordination of social security schemes or bilateral agreements between countries apply. Resident in France (of French nationality or not, but legally resident in the country).<\/p>\n They are active or inactive (retired, capital income).<\/p>\n Households are not the only financial contributors to the system, since companies also contribute, either as employers (employer social security contributions), or as payers of various taxes (CSSS, payroll tax, “pharmaceutical” taxes, etc.).<\/p>\n They may or may not be insured (French citizens living abroad). [\/et_pb_slide][et_pb_slide heading=”L\u2019offre de soins” image=”https:\/\/p4h.world\/app\/uploads\/2023\/05\/2023_05_02_diagramme_France_EN3S_.pptx-1.png” _builder_version=”4.21.0″ _module_preset=”default” body_text_color=”#2D424C” background_color=”#FFFFFF” background_enable_color=”on” text_orientation=”left” custom_padding=”0px|0px|0px|0px|false|false” custom_css_slide_image=”margin-bottom: 30px !important;” global_colors_info=”{}” sticky_transition=”on”]<\/p>\n In terms of healthcare facilities, we distinguish between public and private establishments<\/p>\n In the city, a distinction is made between care provided by the medical professions, and that provided by paramedical professions.<\/p>\n The “city” category includes health centers, in the generic sense (beyond organizational innovations).<\/p>\n Companies belonging to the pharmaceutical industry, which supply the healthcare system with drugs and medical devices.<\/p>\n The French National Authority for Health (HAS) defines the scope of reimbursement, based in particular on the evaluation of medical service rendered.<\/p>\n The Comit\u00e9 \u00e9conomique des produits de sant\u00e9 (CEPS) negotiates the price of marketed drugs and medical devices with companies.<\/p>\n Simplifying assumptions have been used to illustrate the range of healthcare services on offer:<\/p>\n [\/et_pb_slide][et_pb_slide heading=”Gestion du syst\u00e8me de financement” image=”https:\/\/p4h.world\/app\/uploads\/2023\/05\/2023_05_02_diagramme_France_EN3S_.pptx-2.png” _builder_version=”4.21.0″ _module_preset=”default” body_text_color=”#2D424C” background_color=”#FFFFFF” background_enable_color=”on” text_orientation=”left” custom_padding=”0px|0px|0px|0px|false|false” custom_css_slide_image=”margin-bottom: 30px !important;” global_colors_info=”{}” sticky_transition=”on”]<\/p>\n Part of the funding comes from health insurance contributions, which are currently paid solely by employers and the self-employed, and from the CSG, which is paid by the entire population (active, replacement, capital, games, etc.).<\/p>\n Another part comes from other social contributions, taxes and levies, paid either by households or by companies\/employers.<\/p>\n Lastly, there is financing from State credits (Aide M\u00e9dicale d’Etat-AME, urgent care, prevention, health security), which is more modest in financial terms, and is ultimately provided by taxes paid by households or companies.<\/p>\n They collect the bulk of social security contributions and CSG, as well as certain taxes (from complementary health insurance organizations, pharmaceutical laboratories, etc.). The DGFiP also plays a role, either by collecting taxes earmarked for the health insurance scheme, or by collecting taxes that feed the State budget, part of which finances the system.<\/p>\n Since 2016, there has been just one basic health and maternity insurance scheme, Protection universelle maladie (PUMa), managed by CNAM.<\/p>\n The other basic health insurance “schemes”, which manage and cover smaller populations (salaried employees and farmers, railway workers, miners, sailors, military personnel, notary clerks…), are integrated into the PUMa, except for a few specific expenses.<\/p>\n Other players play a less important role. In particular, supplementary social protection, managed for the most part by private organizations (with the exception of Alsace-Moselle), finances around one-sixth of all healthcare expenditure.<\/p>\n [\/et_pb_slide][et_pb_slide heading=”Steering the system is a complex, multi-player affair” image=”https:\/\/p4h.world\/app\/uploads\/2023\/05\/2023_05_02_diagramme_France_EN3S_.pptx-3.png” _builder_version=”4.21.0″ _module_preset=”default” body_text_color=”#2D424C” background_color=”#FFFFFF” background_enable_color=”on” text_orientation=”left” custom_padding=”0px|0px|0px|0px|false|false” custom_css_slide_image=”margin-bottom: 30px !important;” global_colors_info=”{}” sticky_transition=”on”]<\/p>\n It prepares – at ministerial level – Social Security Finance Bills (PLFSS), Finance Bills (PLF) and Public Finance Programming Bills (LPFP).<\/p>\n It also supervises social protection organizations – also at ministerial level.<\/p>\n The Agences R\u00e9gionales de Sant\u00e9 (Regional Health Agencies) – decentralized government departments – supervise (and very partially finance) healthcare establishments.<\/p>\n It creates specialized agencies such as the Haute Autorit\u00e9 de Sant\u00e9.<\/p>\n It amends and votes through the PLFSS, PLF and LPFP, and ordinary laws relating to the healthcare system.<\/p>\n It monitors the application of laws.<\/p>\n It carries out evaluations of the healthcare system.<\/p>\n Professional unions are directly involved in negotiating medical agreements with the Caisse Nationale d’Assurance Maladie (CNAM).<\/p>\n Employees’ unions and employers’ organizations sit on and chair the boards of directors of the social security funds: they sign the COG (conventions d’objectifs et de gestion) with the French government, and issue opinions on draft laws and decrees…<\/p>\n They sit on hospital boards.<\/p>\n They create health centers.<\/p>\n They play an important role in preventive health care.<\/p>\n They set up consultative bodies to bring together all the players involved.[\/et_pb_slide][\/et_pb_slider][\/et_pb_column][\/et_pb_row][et_pb_row disabled_on=”on|on|on” admin_label=”Timelines list” _builder_version=”4.21.0″ _module_preset=”default” disabled=”on” collapsed=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][ba_gradient_heading title=”Timelines” html_tag=”h2″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”Timelines title” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”32px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][dsm_icon_list admin_label=”P4H Styled List Module” _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”0px|0px|0px|0px|false|false” custom_padding=”0px|0px|0px|0px|false|false” link_option_url=”https:\/\/p4h.world\/fr\/levolution-du-financement-de-lassurance-maladie\/” global_colors_info=”{}”][dsm_icon_list_child text=”Changes in the relationships between players in the Universal Health Coverage system” url=”https:\/\/p4h.world\/en\/relationships-between-cmu-players\/” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/dsm_icon_list_child][dsm_icon_list_child text=”Stages in the universalization of health coverage” url=”https:\/\/p4h.world\/en\/stages-of-health-coverage\/” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/dsm_icon_list_child][dsm_icon_list_child text=”Changes in health insurance financing” url=”https:\/\/p4h.world\/en\/changes-in-health-insurance-financing\/” _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/dsm_icon_list_child][\/dsm_icon_list][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.21.0″ _module_preset=”default” max_width=”100%” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.21.0″ _module_preset=”default” header_text_align=”center” background_color=”#e8e7e2″ text_orientation=”center” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_3,1_3,1_3″ _builder_version=”4.21.0″ _module_preset=”default” max_width=”100%” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.21.0″ _module_preset=”default” text_text_color=”#ffffff” header_text_align=”center” header_text_color=”#FFFFFF” background_color=”#4d7d94″ text_orientation=”center” background_layout=”dark” min_height=”210px” height=”100%” custom_padding=”40px|40px|40px|40px|false|false” link_option_url=”https:\/\/p4h.world\/en\/relationships-between-cmu-players\/” custom_css_main_element=”align-content: center;” global_colors_info=”{}” background__hover_enabled=”on|desktop” background_color__hover=”#e8e7e2″ background_enable_color__hover=”on” text_text_color__hover_enabled=”on|hover” text_text_color__hover=”#2d424c” header_text_color__hover_enabled=”on|desktop” header_text_color__hover=”#2d424c” background_layout__hover_enabled=”on|hover” background_layout__hover=”light”]<\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.21.0″ _module_preset=”default” text_text_color=”#ffffff” header_text_align=”center” header_text_color=”#FFFFFF” background_color=”#2e424b” text_orientation=”center” background_layout=”dark” min_height=”210px” height=”100%” custom_padding=”40px|40px|40px|40px|false|false” link_option_url=”https:\/\/p4h.world\/en\/stages-of-health-coverage\/” custom_css_main_element=”align-content: center;” global_colors_info=”{}” background__hover_enabled=”on|desktop” background_color__hover=”#e8e7e2″ background_enable_color__hover=”on” text_text_color__hover_enabled=”on|hover” text_text_color__hover=”#2d424c” header_text_color__hover_enabled=”on|hover” header_text_color__hover=”#2d424c” background_layout__hover_enabled=”on|hover” background_layout__hover=”light”]<\/p>\n [\/et_pb_text][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.21.0″ _module_preset=”default” text_text_color=”#ffffff” header_text_align=”center” header_text_color=”#FFFFFF” background_color=”#891a21″ text_orientation=”center” background_layout=”dark” min_height=”210px” height=”100%” custom_padding=”40px|40px|40px|40px|false|false” link_option_url=”https:\/\/p4h.world\/en\/changes-in-health-insurance-financing\/” custom_css_main_element=”align-content: center;” global_colors_info=”{}” background__hover_enabled=”on|desktop” background_color__hover=”#e8e7e2″ background_enable_color__hover=”on” text_text_color__hover_enabled=”on|hover” text_text_color__hover=”#2d424c” header_text_color__hover_enabled=”on|hover” header_text_color__hover=”#2d424c” background_layout__hover_enabled=”on|hover” background_layout__hover=”light”]<\/p>\n [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.21.0″ _module_preset=”default” background_color=”#dce5ea” global_colors_info=”{}”][et_pb_row admin_label=”Documents list” _builder_version=”4.21.0″ _module_preset=”default” background_color=”#dce5ea” custom_padding=”25px|15px|15px|15px|false|false” collapsed=”off” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][et_pb_code _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n [\/et_pb_code][et_pb_code _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/p>\n <\/ul>\n [\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":" The P4H Network and the French National School for Social Security [\u00c9cole nationale sup\u00e9rieure de S\u00e9curit\u00e9 sociale] (EN3S)\u00a0have been collaborating to document and share knowledge about France\u2019s SHP system\u00a0and experience in SHP. France\u2019s experience in social health protection (SHP) is one of the richest in the world. The results are noteworthy. This page invites visitors…<\/p>\n","protected":false},"author":1,"featured_media":987536488,"template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":""},"acf":[],"_links":{"self":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/country\/987495606"}],"collection":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/country"}],"about":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/types\/country"}],"author":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/users\/1"}],"version-history":[{"count":35,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/country\/987495606\/revisions"}],"predecessor-version":[{"id":987785073,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/country\/987495606\/revisions\/987785073"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/media\/987536488"}],"wp:attachment":[{"href":"https:\/\/p4h.world\/en\/wp-json\/wp\/v2\/media?parent=987495606"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}The individual is at the heart of the system<\/h2>\n
The individual is a patient who uses the healthcare system<\/h3>\n
If the individual is a foreigner in an irregular situation, then AME or urgent care benefits apply.<\/p>\nThe individual is an insured person (and the members of his or her household), who finances the healthcare system<\/h3>\n
The individual is a French citizen who elects his or her representatives, notably in presidential and legislative elections<\/h3>\n
They may or may not be patients!<\/p>\nThe city\/hospital dichotomy structures supply, and drugs are specifically regulated<\/h2>\n
Half of care is provided in hospitals, and half in towns and cities<\/h3>\n
The healthcare system is supplied with drugs and medical devices, which are subject to specific regulations.<\/h3>\n
Note<\/h3>\n
\n
Health insurance, and CNAM in particular, at the heart of the financing system<\/h2>\n
Health care is essentially financed by insured persons\/households and their employers<\/h3>\n
The sums collected by the other basic schemes or by the OCs are much more modest.<\/p>\nThe major role of CNAM<\/h3>\n
Steering the system is a complex, multi-player affair<\/h2>\n
The role of the government is to provide overall direction<\/h3>\n
Parliament plays its legislative role<\/h3>\n
Social partners are part of the system’s governance<\/h3>\n
Local executives are involved at local level<\/h3>\n
TIMELINES<\/h3>\n
Changes in the relationships between players in the Universal Health Coverage system<\/h3>\n
Stages in the universalization of health coverage<\/h3>\n
Changes in health insurance financing<\/h3>\n
Related Documents<\/h3>\n<\/div>\n
<\/p>\n
Population, financement et d\u00e9penses au 1er janvier 2023 (PDF)<\/a><\/h4>\n<\/li>\n
Panier de soins (PDF)<\/a><\/h4>\n<\/li>\n
Perte d’autonomie (PDF)<\/a><\/h4>\n<\/li>\n
Assurance maladie (PDF)<\/a><\/h4>\n<\/li>\n
Accidents du travail (PDF)<\/a><\/h4>\n<\/li>\n