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Chapter 3 | The impact of the crisis on the health system and health in France
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4.3 Impact on efficiency
Overall, the health care budget deficit was halved between 2009 and 2012, in
part through an increase in SHI revenues and efficiency improvements, in spite
of the fact that the volume of consumption of medical products and services
increased by 2.8% in 2011, following a similar increase in 2010. However, the
budget deficit reduction was mainly achieved through a reduction in hospital
fees and drug prices. This worked as a buffer against the increase in prices of
ambulatory health care services (Le Garrec, Bouvet & Koubi, 2012), which
partly reflected the introduction of the pay-for-performance scheme.
4.4 Impact on health
There is no specific monitoring of the impact of the economic crisis on health
or related socioeconomic factors, but several surveys provide an overall picture
on perceived health status and socioeconomic factors. For example, the Ministry
of Health Directorate of Research, Studies, Evaluation and Statistics has
commissioned an annual survey since 2000 that poses questions to a sample of
about 4000 people on various socioeconomic issues (DREES, 2012d). During
the course of the crisis, respondents perceived growing social injustice, decreasing
confidence that the government can adequately address poverty and social
exclusion, and decreasing belief that health insurance should be universal. At the
same time, the percentage of respondents perceiving their health status as good rose
to 74% in 2011, after a reported 71% in 2009 and 2010; likewise, access to health
care continued to be considered universal by a high percentage of respondents
(72%). At the same time, 26% thought themselves to be in poor health and
among those, 6% in bad or very bad health; these results have remained stable
and similar to previous years. Another report on poverty and social exclusion has
been published every year since 2000 by the National Observatory in Poverty and
Social Exclusion (Observatoire National de la Pauvreté et de l'Exclusion Sociale).
In its report for 2012, the Observatory highlighted a steep increase in household
debt overload in 2008 and a rise in poverty that was particularly marked for
young adults (Observatoire National de la Pauvreté et de l'Exclusion Sociale,
2012). Finally, a scientific publication reported a significant increase in suicide
rates for men (but not for women), by 4.7% in 2009 (representing 344 excess
suicides) in comparison to increases of 5.5% in Germany and 10.4% in Greece
(Chang et al., 2013).
Preparedness
Overall, two measures that were developed before the onset of the crisis may
be considered to be the elements that buffered the impact of the crisis on
individuals (at least to some extent). First, the active solidarity income was