Achieving universal health coverage in France: policy reforms and the challenge of inequalities

Abstract

Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act

“…40 International experience suggests that a universal, comprehensive national health insurance program would most effectively reduce household spending and ameliorate disparities. 41…”

Development of School Nursing in the World and Turkey

“…Okul hemşireleri okullarda sağlık bilgisi vermekte, sağlık sorunları olan çocuklara destek sağlamakta ve sağlığı koruyucu girişimlerde bulunmaktadır. (19,20) Fransa'da okul çağındaki çocuklar için temel halk sağlığı hizmetleri 5-19 yaşlarını kapsamaktadır. Bu hizmetler okul toplumunun sağlığının geliştirilmesi, korunması ve hastalıkların önlenmesi için gerekli olan halk sağlığı uygulamalarını içermektedir.…”

A theory of predatory welfare state and citizen welfare: the French case

“…"Created under the guise of modernizing public health policy, these agencies merged the regional and local offices of the Ministry of Health and the health insurance funds to improve regional coordination in providing care. Instead of respecting the principle of autonomy that guided the founding of these regulatory agencies, these reforms in fact helped the Ministry of Health regain control of the hospital sector" (Nay et al 2016(Nay et al , p. 2240.…”