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Chapter 3 | The impact of the crisis on the health system and health in France
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Overall, the share of the French population satisfied with access to health care
decreased from 82% in 2007 to 68% in 2013 (physicians), and from 81 to 70%
(dentists). This may be explained, in part, by higher medical fees. Between 2007
and 2012, the share of GPs practising extra-billing grew from 15.5 to 17.4%,
while for specialists it increased from 49 to 53% (Coppoletta & Le Palud, 2014).
Two other factors serve to illustrate the increasing inequity in the system. First,
since 2002 there has been a disconnection between increases in net income
and private health expenditure. Since the latter is growing faster, patients
increasingly have to rely on VHI or OOP payments, both of which reduce
equity in financing (Fig. 3.5). This seems particularly noteworthy given that
nearly 4 million people did not have complementary VHI in 2008 (Perronnin,
Pierre & Rochereau, 2011). Second, between 2008 and 2010, the private
health expenditure of intensive users of care increased more rapidly than that
of less frequent users of care (Fig. 3.6). This strongly suggests that patients with
high needs experienced a loss of coverage over time, which is a strong indicator
of financial inequity. Finally, a striking indicator of increasing financial inequity
appears to be the emergence of a "microcredit for health" of €600–4000 for
6–36 months at an interest rate of about 5% (Banque du Crédit Municipal
de Paris, 2008; Les Echos.fr, 2010). This loan is proposed by a publicly owned
bank, and its main users are unemployed single mothers. The need to increase
individuals' ability to pay for health care is consistent with recent results of a
three-year survey assessing the funds that a person estimates to have set aside
for OOP payments: the amount has decreased from €570 in 2012 to €568 in
2013, and to €523 in 2014 (Sofinscope, 2014).
Fig. 3.5 Evolution of private health expenditure and net income in France, 1995–2012
Increase from index value (%)
220
200
180
160
140
120
100
1995
Private health
expenditure
Notes: 1995 taken as the index value of 100.
Source: High Council for the Future of Health Insurance, 2013.
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Net income