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90 Economic crisis, health systems and health in Europe: country experience
Fig. 3.6 Private health expenditure by percentile of health service users in France,
2008–2010
4000
3500
10th percentile
60th percentile
90th percentile
99th percentile
Expenditure (€)
3000
2500
2000
1500
1000
500
0
2008 2009 2010
Source: High Council for the Future of Health Insurance, 2012.
However, it seems likely that some inequities have been attenuated for the
least well-off. There was a slight increase in the number of recipients of the
CMU-C from 4.12 million in 2009 to 4.9 million in 2013 and a marked
rise in beneficiaries of the ACS scheme, whose number almost doubled
from 469 000 in 2007 to nearly 1.1 million in 2013 (Couverture Maladie
Universelle, 2013).
At the same time, in a context in which there is diminishing coverage by SHI,
more than 40% of French citizens say that they would prefer to pay more
while maintaining the level of social protection, whereas fewer than 30% would
prefer a lower level of social protection in exchange for lower contributions
(Coppoletta, 2012). This is consistent with findings from a 2010 survey in
which respondents expressed a higher need for social protection since the onset
of the crisis, concomitant with a steady decrease in optimism for themselves
and future generations (DREES, 2012b).
In addition, it is interesting but perhaps not surprising to note that the financial
situation of VHI organizations did not significantly deteriorate during the
crisis, despite the obvious effects that the shrinking employment sector had
on VHI contracts offered through employers. This is, in part, explained by
the decreasing coverage by SHI, the sustained demand for social protection,
as discussed above (Caniard & Meyer, 2012), and the fact that the most costly
patients are fully covered by SHI under the chronic illness (affection de longue
durée) scheme.