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88 Economic crisis, health systems and health in Europe: country experience
estimated that complementary VHI covered about 13% of all health care expenses
in France, which is a larger share than in other European countries (Thomson,
Foubister & Mossialos, 2009). On average, it also results in the lowest OOP
expenditure among OECD countries. Nonetheless, the increased participation of
VHI in health care financing during the crisis has decreased equity in financing
because SHI contributions are income related, while VHI premiums usually are
not. Consequently, wealthier people spend a lower proportion of their incomes
on health care compared with the poor. Moreover, certain population groups,
such as the unemployed and the retired, cannot benefit from the more favourable
premiums and terms of group contracts.
4.2 Access to services and quality of care
Concerning utilization, an increasing proportion of individuals reported in 2010
that they had unmet health care needs for financial reasons. This may be because
of the imposition of new or increased user charges, including extra-billing, which
limits access to specialist care. Indeed, 15.4% of the population said they did
not access health care in 2008 because of the associated expenses (1.2% more
than in 2006). However, this mainly concerned services such as dental care
(10%), optometry services (4%) and, to a lesser extent, doctor consultations
(3.4%). Forgoing care was more frequent among patients who did not have
complementary VHI (over 30% of people in this group; Després et al., 2011).
Likewise, a study conducted in 2012 showed that one in five recipients of social
benefits (minima sociaux) did not access medical care for financial reasons within
the previous year (Isel, 2014). Another cohort study conducted in 2010 in Paris
(3000 people surveyed) found similar results. It reported that 30% of respondents
did not seek medical care when they needed it, half of them for financial reasons
(DREES, 2012a). In addition, a study by the nongovernmental organization
Médecins du Monde reported that the proportion of people delaying seeking
care increased from 11% in 2007 to 17% in 2008, 22% in 2009 and 24% in
2010. The financial barriers to access health care are further compounded by
socioeconomic inequalities, as illustrated by Table 3.2.
Table 3.2 Social inequalities in health and access to care between workers and
managers in France
Average
No. diseases
declared
Obesity
(%)
Dental
problems
(%)
Access
to dental care
in the previous
two years (%)
Workers 2.9 15.2 44.0 63.9
Managers 2.5 6.3 29.4 82.3
Sources: Dourgnon, Jusot & Fantin, 2012; Calvet et al., 2013; OECD, 2013.