France: #17 in the 2024 World Index of Healthcare Innovation

Introduction

France’s predominantly government-operated healthcare system climbed to 17th in the 2024 World Index of Healthcare Innovation, an improvement from its 24th position in 2022. Since the first iteration of WIHI in 2020, no country has risen the ranks faster, up 11 spots.

In Fiscal Sustainability, France ranked 30th, ahead of only Japan and the United States. French legislators continue to struggle with developing strategies to manage the growing expenses of government healthcare without triggering significant public opposition.

Although France allows free choice of healthcare providers, its single-payer system limits access to the most cutting-edge medications and France also has been slow to embrace generics as a cost-control strategy. France’s strongest performance was in Choice, where it ranked 10th, largely due to the lowest rate of household catastrophic health spending and complete choice of primary care providers and specialists. However, it ranked lower in Quality and Science & Technology, at 12th and 14th respectively.

Background

France’s healthcare system was established in the 1930s, initially providing mandatory, subsidized health insurance for workers earning below a certain income threshold. By 1939, the system had expanded significantly, with two-thirds of the French population covered by private health insurance through mutual benefit associations. After World War II, the system evolved from a German-style model based on private insurers to a more centralized, government-led approach.

In 2016, France implemented a major reform with the introduction of the Protection Universelle Maladie (PUMA), unifying several occupation-based government-run insurers into one cohesive system. In 2024, approximately 95 percent of the French population is enrolled in PUMA, and over 92 percent of residents have additional private health insurance to cover benefits and out-of-pocket costs not provided by the government.

France is a significant contributor to the global pharmaceutical market, hosting major firms like Sanofi, which evolved from mergers between various historic French and German companies. Other significant players include Ipsen, Servier, and Pierre Fabre. The Comité Économique des Produits de Santé plays a crucial role by negotiating drug prices. Since the penetration of generic medicines in the French market is low at roughly  30 percent, pharmaceutical firms achieve substantial revenues from drugs beyond their patent periods.

France’s healthcare model is a hybrid system combining public and private elements. The public sector, financed through taxes and social security contributions, ensures universal coverage and access to essential health services under PUMA. In 2023, health expenditure accounted for approximately 11 percent of GDP, reflecting the government’s commitment to healthcare. The private sector offers supplementary insurance that enhances the scope of services available, such as elective procedures and advanced drug treatments, which are only partially covered by public insurance. This system achieves a balance between comprehensive coverage and high-quality care, maintaining France’s ranking among the top countries for healthcare efficiency and patient satisfaction.

Dimension Performance

Quality

Consistent with its reputation for longevity and wellness, France ranks 12th in the Quality dimension. The country boasts a robust healthcare infrastructure (13th), led by efficient use of hospital capacity.  It also performs well in disease prevention (14th), particularly on cardiovascular survival and low rates of treatable mortality. While France ranks near the median in pandemic preparedness at 15th, it excels in patient-centered care, ranking 9th.

Choice

France ranks 10th overall for Choice. While France ranks near the top of the Index in both affordability of health coverage (4th) and access to new treatments (4th), its overall Choice ranking is weighed down by a low score in freedom to choose healthcare services (23rd). France’s two-tiered health insurance system—which helps eliminate out-of-pocket costs through supplemental insurance—nevertheless weakens patient choice by making consumers less sensitive to the price of healthcare. In addition, there is virtually no choice in insurance carrier or plan design, with a single basic insurance choice determined by profession.

Science and Technology

France receives relatively high grades (14th) in Science and Technology, thanks to its tradition as a leader in scientific discoveries (7th), including the fourth highest score for Nobel laureates and a significant body of cited research. However, France lags behind the median in health digitization (23rd) as it falls short of universal electronic health record adoption.

Fiscal Sustainability

France ranks 30th in Fiscal Sustainability, worse than only Japan and the United States in this dimension. Notably, its public health spending per capita exceeds nine percent and is ranked 31st, reflecting nearly a full percentage point increase over the past decade. Without implementing additional cost containment measures, the ongoing rise in public health spending (12th) poses a risk to France’s national solvency, which already sits near the bottom at 25th.