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82 Economic crisis, health systems and health in Europe: country experience
On the fiscal side, the share of tobacco tax revenues earmarked for health
was increased in 2007 to 98.75% taking effect from 2009, and the share of
capital gains tax revenues earmarked for health was increased from 12.3% to
13.5% in 2011. Since 2013, tobacco products that previously benefited from
a reduced tax rate are taxed like cigarettes, with a mean contribution of about
81% of the end price. Moreover, a new tax on beer was introduced in 2013
and earmarked for health, generating an expected €480 million. Likewise,
since 2012, a new tax on soft drinks of €0.04 per litre has been levied and
earmarked for health. In addition, the new social security contribution
introduced in 2009 (forfait social sur l'épargne salariale) was increased from
2% in 2009 to 4% in 2010, 6% in 2011, 8% in January 2012 and 20% in
August 2012 (Marc, 2012). Currently, 25% of these revenues are earmarked
for health. Finally, an increase in the earmarked tax for funding social security
was implemented for individuals with annual earnings of over €150 000
in 2013.
To meet EU fiscal targets, the government's deficit plan proposed an
additional allocation of taxes to social security in 2012 to be partly financed
by reducing tax shelters for payroll taxes earmarked for social security.
The reduction in health expenditure of €2.4 billion planned for 2013
was divided between ambulatory care (€1.75 billion) and hospital care
(€0.65 billion) and was to be achieved mainly through lower prices for
drugs and medical devices in ambulatory and hospital care (€1 billion)
and by eliminating inappropriate and unnecessary care. The latter measure
is partly set within the national agreement with self-employed physicians,
based on increased financial incentives (e.g. targets related to the appropriate
prescription of antibiotics).
In terms of the SHI revenue base, from 2013 onwards, SHI contributions
increased for self-employed people with annual earnings above a certain
threshold and, under certain conditions, for elected local officials and people
who employ domestic help. In addition, from 2013 onwards, employers
have to pay contributions (forfait social) on a portion of severance paid to
employees in the context of employment termination by mutual consent.
Finally, a new tax (earmarked for the social security budget) has been levied
since 2013 on employees with annual earnings over €150 000.
Regarding sources of revenue, the pre-crisis trend of shifting financing from
SHI towards private expenditure continued during this period. The SHI share
of total health expenditure decreased slightly from 73.8% in 2007 to 73.1%
in 2011, while the share financed by VHI increased from 13.4 to 13.9% and
the share of OOP expenditure increased from 6.8 to 7.5% (Fig. 3.3).