1. Comments from France on the 2013 Commonwealth Fund Survey
Pr Isabelle Durand-Zaleski

2. Key findings High population coverage by statutory health insurance
Average:
Spending
Access
Waiting times
High complexity and costs of supplemental health insurance

3. The four paradoxes
Every person is covered but not for 100% of their expenditures
Single payer system for the statutory health insurance (SHI) but huge complexity for voluntary health insurance (VHI)
Free choice of physician, but dissatisfaction with access
Expensive for the payer but 2nd worst in financial access to care

4. Coverage Good for hospital care
Medium for out of hospital with incentives to use gatekeeper and to use generics
Very poor for eye and dental care

5. Complexity SHI: ensure that entitlement is recognized
For means-tested government sponsored supplemental insurance, about 50% of the eligible population has registered
For employer-sponsored or self paid VHI: complex, opaque (Le Monde survey) with hidden costs

6. Choice and dissatisfaction with the system
Patients want to choose their physician, not their insurer (evidence from the government-sponsored program)
Dissatisfaction with access:
Télémédicine experiments

7. Expensive for the payer but 2nd worst in financial access
Extra billing: 2013 agreement to limit extra billing to 150% of the official tariff eg 70€ for a specialist visit
Direct third-party payment from SHI to physicians (resisted by physicians’ unions)
Suggested reforms (not implemented):
Out of pocket payments based on income
Free hospital care

8. National strategy 2014 Increase generic use Reduce medication volume
Control medication costs
Fight against fraud and abuse