Web-economic-crisis-health-systems-and-health-web
Web-economic-crisis-health-systems-and-health-web 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
380 Economic crisis, health systems and health in Europe: country experience % France: Fig. 1 Economic and fiscal indicators 2000–2007 and 2008–2011 60 55 50 45 40 35 30 25 20 15 10 5 0 −5 −10 −15 −20 −25 −30 _ _ _ _ ● ● _ _ ● ● _ _ _ ● _ Real GDP per capita growth _ _ _ _ _ ● ● _ _ ● ● ● _ _ _ Deficit/surplus (% GDP) _ _ _ _ _ _ _ _ _ _ ● ● _ _ _ ● _ ● _ ● _ _ _ _ _ Government spending (% GDP) _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Government health spending (% total government spending) _ _ _ _ _ _ ● _ ● ● ● ● _ _ _ 10−year bond rates _ _ _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Unemployment rate Notes: Deficit/surplus: Eurostat; 10-year bond rates: European Central Bank; Other indicators: WHO Health for All. Year 2000−2007 2008 2009 2010 2011 France: Fig. 2 Trends in per capita spending on health, 2000–2011 3000 Public spending per capita OOP spending per capita Non−OOP private spending per capita Per capita spending $, PPP 2000 1000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 12 Growth % 8 4 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Public spending per capita growth OOP spending per capita growth Note: Spending calculated from WHO Health for All. Non−OOP private spending per capita growth
- Page 362 and 363: Austria Thomas Czypionka and Maria
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- Page 366 and 367: Azerbaijan Fuad Ibrahimov Economic
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- Page 382 and 383: Bulgaria Antoniya Dimova and Mina P
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- Page 390 and 391: Cyprus Elisavet Constantinou and Ma
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- Page 394 and 395: Czech Republic Tomáš Roubal and J
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- Page 404 and 405: Estonia Triin Habicht and Mall Lein
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- Page 408 and 409: Finland Jan Klavus and Lauri Vuoren
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- Page 420 and 421: Germany Klaus-Dirk Henke and Wilm Q
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- Page 444 and 445: Israel Bruce Rosen and Amir Shmueli
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- Page 458 and 459: Latvia Uldis Mitenbergs and Maris T
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380 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />
%<br />
France: Fig. 1 Economic <strong>and</strong> fiscal indicators 2000–2007 <strong>and</strong> 2008–2011<br />
60<br />
55<br />
50<br />
45<br />
40<br />
35<br />
30<br />
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
−5<br />
−10<br />
−15<br />
−20<br />
−25<br />
−30<br />
_ _<br />
_ _<br />
● ●<br />
_ _<br />
●<br />
●<br />
_ _<br />
_<br />
●<br />
_<br />
Real GDP<br />
per capita growth<br />
_ _<br />
_ _ _<br />
● ●<br />
_ _<br />
●<br />
● ●<br />
_ _ _<br />
Deficit/surplus<br />
(% GDP)<br />
_ _ _ _ _ _ _ _<br />
_ _<br />
●<br />
●<br />
_ _<br />
_<br />
● _ ●<br />
_<br />
●<br />
_ _ _ _ _<br />
Government<br />
spending<br />
(% GDP)<br />
_ _ _ _ _<br />
● ● ● ● ●<br />
_ _ _ _ _<br />
Government<br />
<strong>health</strong> spending<br />
(% total government<br />
spending)<br />
_ _ _ _ _<br />
_ ● _ ●<br />
●<br />
●<br />
●<br />
_ _ _<br />
10−year<br />
bond rates<br />
_ _ _ _ _<br />
_ _<br />
●<br />
●<br />
●<br />
●<br />
●<br />
_ _ _ _ _<br />
Unemployment<br />
rate<br />
Notes: Deficit/surplus: Eurostat; 10-year bond rates: European Central Bank; Other indicators:<br />
WHO Health for All.<br />
Year<br />
2000−2007 2008 2009 2010 2011<br />
France: Fig. 2 Trends in per capita spending on <strong>health</strong>, 2000–2011<br />
3000<br />
Public spending per capita OOP spending per capita Non−OOP private spending per capita<br />
Per capita spending $, PPP<br />
2000<br />
1000<br />
0<br />
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />
12<br />
Growth %<br />
8<br />
4<br />
0<br />
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />
Public spending<br />
per capita growth<br />
OOP spending<br />
per capita growth<br />
Note: Spending calculated from WHO Health for All.<br />
Non−OOP private spending<br />
per capita growth
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