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78 Economic crisis, health systems and health in Europe: country experience
1.3 Broader consequences
At the household level, the effect of falling house prices on household wealth
and consumption was lower than in countries with greater exposure to the
real estate crisis (Fig. 3.1). Indebtedness levels were much lower in France
because there were generally stricter lending conditions. Moreover, with a
savings ratio of 12% at the onset of the crisis, households were able to resort
to their assets. The bankruptcy rate remained relatively low and consumption
remained fairly stable at the beginning of the crisis. However, unemployment
rates sharply increased from a 10-year low of 7.2% in early 2008 to 9.6% by
the end of 2009, with more moderate increases in 2010 and 2011 (OECD,
2009) (Table 3.1).
Fig. 3.1 Household mortgage debt in France as percentage of disposable income,
1991–2007
160
France
Germany
United States
United Kingdom
140
% of disposable income
120
100
80
60
40
1991 1993 1995 1997 1999 2001 2003 2005 2007
Source: OECD, 2009.
2. Health system pressures prior to the crisis
Major structural problems in the French health system prior to the crisis included
lack of coordination between hospital and ambulatory services, between private
and public provision of care, and between health care and public health (the
last being concerned with prevention rather than care delivery). At the onset of
the crisis, the Ministry of Health was preparing the Hospital, Patients, Health
and Territories bill aimed at integrating public health, health care delivery and
financing by creating a one-stop shop at regional level, the regional health
care agencies (agences régionales de santé). Since 2010, the regional health care
agencies in the 26 French regions govern all these aspects of the health system