France: #24 in the 2022 World Index of Healthcare Innovation

Introduction

France’s mostly government-run health care system ranked 24th in the 2022 World Index of Healthcare Innovation, up from 25th in 2021 and 28th in 2020.

France was ahead of only Japan and the United States in Fiscal Sustainability (30th). Lawmakers in France have yet to decipher a way to address the scale and growth of government health care spending without sparking a large public backlash.

Though choice of providers is free and open, France’s baseline single-payer system restricts access to the most innovative medicines and struggles to fully adopt generics as an alternative method to control costs. On a relative basis, France performed best in Science and Technology (13th), owing to an efficient hospital system, and occupied a lower position (18th) in both Quality and Choice.

Background

In 1930, France established a system of mandatory, subsidized health insurance for workers below an income threshold. Private health coverage through mutual benefit associations was widespread; by 1939, two-thirds of French residents had health insurance. After World War II, France began its gradual move away from the German-style model of private insurers and toward a more government-centered system.

In 2016, France enacted a major overhaul of its health care system, consolidating its various occupation-based government-run insurers into a single system, the Protection Universelle Maladie (PUMA). More than 90% of the French population purchases supplemental private insurance, which provides benefits and out-of-pocket costs not covered by the government-run system, akin to Medicare supplemental insurance (“Medigap”) in the U.S.

France is home to one of the world’s largest innovative pharmaceutical companies, Sanofi, which is the product of mergers of several longstanding French and German companies. Other large French companies include Ipsen, Servier, and Pierre Fabre. A government agency, the Economic Committee for Health Products (Comité Économique des Produits de Santé, or CEPS), negotiates drug prices; however, generic medicines have fairly low market share in France, allowing pharmaceutical companies to generate considerable revenues from drugs whose patents have expired.

Quality

Lining up with its reputation of longevity and wellness, France performs best in the Quality dimension at 18th. France’s health care infrastructure (7th) is solid, and the country holds its own in measures of disease prevention (13th). France remained behind the median in measures of pandemic preparedness (21st) but fell significantly in patient-centered care (24th), down from 11th in 2021 — a result of substantial decreases in patient safety measures.

Choice

France ranks 18th overall for Choice. While France ranks above the median in affordability of health insurance (10th), its overall Choice ranking is weighed down by a low score in freedom to choose health care services (27th). 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 health care. In addition, there is virtually no choice in insurance carrier or plan design, with a single basic insurance choice determined by profession.

Science & Technology

France receives relatively high grades (13th) in Science and Technology, thanks to its tradition as a leader in scientific discoveries (7th), the fourth highest score for Nobel laureates, and a significant body of cited research. However, France lags behind the median in health digitization (19th).

Fiscal Sustainability

France’s Fiscal Sustainability ranking comes in at 30th, better only than Japan and the United States. In particular, its public health spending per capita exceeds 9% (31st), having grown almost a full percentage point in the last 10 years. Without further cost containment measures, continued growth in public health spending (27th) will threaten France’s national solvency — which already ranks near the bottom (24th) among countries in the Index.