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Chapter 3
The impact of the crisis on the health
system and health in France
Matthias Brunn, Karen Berg Brigham, Karine Chevreul and
Cristina Hernández-Quevedo
Introduction
In France, pre-existing fiscal pressures, which were aggravated by the economic
crisis, led to the continued use of a familiar set of cost-containment tools being
implemented after 2008. In this sense, the main budgetary responses have
not been specific to the economic crisis. So far, the business-as-usual focus
on containing expenditure has been successful; for example, the health care
budget deficit overall was halved between 2009 and 2012, in part through an
increase in statutory health insurance revenues and efficiency improvements,
despite increases in the consumption volumes of medical products and services.
Nevertheless, it is not clear whether the full impact of the crisis is yet to come, and
barriers to more substantial reform are rooted in the institutional complexity of
the French health care system, including the relationship between the state and
the statutory health insurance (SHI) system; the organizational structure and
payment system; and the lack of integrated and comprehensive approaches. In
addition, the need to address the issue of equitable health financing is apparent,
particularly given increases in private health expenditure and its impact on
people with low incomes and high health needs.
1. The nature and magnitude of the financial and
economic crisis
1.1 The origins and immediate effects of the crisis
The 2008 recession marked the end of a growth cycle in France dating back to
2002, as the impact of the May 2007 subprime crisis finally manifested itself
in the real economy. Growth had already begun to slow in the previous year
in the face of falling housing investment, increasing trade deficits and rising