|Titel:||ESPN Thematic Report on Inequalities in access to healthcare : France 2018|
|Autor:||Réseau européen de politique sociale, Author ; Commission européenne, Author ; Union européenne, Author ; Huteau, Gilles, Author|
[Mots-clés] Santé - soins
[Mots-clés] Accès aux soins
[Mots-clés] Couverture maladie universelle (CMU)
[Mots-clés] Protection sociale complémentaire
[Mots-clés] Protection et sécurité sociale
[Mots-clés] Vulnérabilité économique
The French health system gives patients and doctors a great deal of freedom, at the same time as guaranteeing extensive coverage of health expenditure. The social security health insurance system is generalised to cover the entire population with a comprehensive care package.
Most people also have a complementary health plan (95% of the population), which they either take out individually or through their employer. Since 2000, people on low incomes (up to €8,810 per year for a single person, depending on household size) have benefited from a specific measure called couverture maladie universelle complémentaire (CMU-c), which is granted with no need for contributions.
As a result, in France patients’ out-of-pocket spending on healthcare and medical goods is in net terms half that of other European countries. After reimbursements from the social security health insurance system (covering on average 77% of spending) and complementary health insurance, just 8.3% is borne by households.
Nevertheless, a noteworthy 5% of the French population do not have complementary coverage. This mainly concerns the unemployed and retired people with low pensions.
With the exception of beneficiaries of CMU-c, patients can be subject to significant co-payments when they find themselves confronted with medical fees in excess of the health insurance reimbursement tariffs; or with poorly reimbursed expenditure on optical items and prosthetics. These two types of situation are in fact the reason for most non-take-up of healthcare by people on low incomes.
In addition to this financial obstacle to accessing healthcare, regional disparities in the availability of healthcare are also an issue. While France ranks as average in Europe in terms of medical services density, access to care has become difficult in some geographic areas, mainly in rural zones, because of the shortage of practising doctors. This problem is set to get worse in coming years as large numbers of retiring doctors are not replaced.
Beyond these more visible aspects, inequalities in access to care stem from other factors. They reflect differences in socio-cultural behaviour and economic insecurity, which in particular make women from disadvantaged groups less likely to take up preventative care. They are also particularly marked for some female pathologies, as illustrated by disparities in access to breast cancer screening.
Appraisal of health inequalities is based on the collection of statistics by state services and the work of research teams from public institutions and universities.
In particular, the accent is on measuring and explaining the non-take-up of healthcare based on surveys that consist in questioning a broad panel of health system users. However, given the disparities between the results obtained in different surveys, the analysis of the collected data remains to be consolidated.
However, the creation of a new indicator of disparities in healthcare availability (local potential accessibility - accessibilité potentielle localisée − APL) marks a substantial step forward insofar as it takes into account the level of activity of healthcare professionals and the characteristics of healthcare demand over a given geographic area. This creates the conditions for a more detailed analysis of regional disparities by adding other available data such as ‘access time by road in minutes’.