This is in a nutshell my own condensed analysis of the French universal health care system, combining universal coverage with a public-private mix of hospital and ambulatory care and a higher volume of service provisions than in the United States. It must be understood when studying the French system that universal coverage can thus be achieved without excluding private insurers from the supplementary insurance market.
The French health care system was rated the best in the world by the World Health Organization in 2001 while the US health care system ranked 37th. In 2004, France spent 10.5% of its gross domestic product (GDP) and it increased to 11.5% of GDP on health care in 2017. By contrast, the US spent 18% of its GDP on health care in the same year. Payroll taxes in France provide 53% of funding, with employers paying 80% of the tax and employees paying the rest. In addition, a national earmarked income tax contributes 34% of funding, and State subsidies account for 1% of funding.
Universal coverage was achieved over seven decades by extending statutory health insurance (SHI) to all employees (in 1945), retirees (in 1945), the self-employed (in 1966), and the unemployed (in 2000). In 2000, the Couverture maladie universelle (Universal Health Coverage), or CMU, was created for residents not eligible for SHI, although the program required yearly renewals and entitlement changes whenever a beneficiary’s professional or family situation changed. After the implementation of CMU, fewer than 1% of residents were left without baseline coverage.
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