Web-economic-crisis-health-systems-and-health-web

France
Karine Chevreul, Karen Berg Brigham and Sandra Mounier-Jack
Economic trends
• Real per capita GDP in France declined slightly in 2009 by 1.1% and
returned to positive growth by the following year. Government expenditure
as a share of GDP increased since 2008, as have budget deficits.
• Ten-year bond rates have fallen and are slightly lower than rates in the
United Kingdom but higher than rates for countries such as Germany
and the Netherlands.
• Unemployment rate increased since the onset of the crisis; in 2012 it was
just below the European average.
• Health as a share of government expenditure, which is just below the
European average, is lower than it was in 2008. Per capita spending by
public and private sources slowed in 2010 but growth accelerated in 2011
(France: Figs 1 and 2).
Policy responses
Changes to public funding for the health system
• The health budget deficit increased by approximately two and a half times
between 2008 and 2010 (rising from €4.4 billion to €11.9 billion) but was
reduced (to €8.6 billion) in 2011 through better expenditure control and
an increase in revenues; an amendment to the 2012 budget was passed to
reduce the health budget deficit to €5.5 billion and the planned deficit for
2013 was €5.1 billion; in 2010 the national ceiling for SHI expenditure
(objectif national des dépenses d'assurance maladie) was met for the first time
since 1997.
• The share of tobacco tax revenues earmarked for health was increased
to 98.75% with effect from 2009 (2007); the share of capital gains tax
revenues earmarked for health was increased from 12.3% to 13.5%
(2011); a new tax on beer was introduced and will be earmarked for health,
generating an expected €480 million (2013); the new social security
contribution introduced in 2009 (forfait social sur l'epargne salariale) was
increased from 2% in 2009 to 4% in 2010, 6% in 2011, 8% in January
2012 and 20% in August 2012; a percentage of these revenues has been
earmarked for health since 2010; an increase in the earmarked tax for