The social security spending budget approved by parliament for 2024 is nearly 255 billion euros, placing France in third position behind the United States and Germany in terms of percentage of GDP. However, when looking at dollars spent per person per year, France is in seventh position with 6,630 dollars, almost 20% less than Germany according to the OECD’s “Health at a Glance 2023” report. The Minister of Economy aiming to make savings in healthcare costs should focus on management fees, which are significantly higher in France compared to other OECD countries.
Historically, France has a dual management system for healthcare services, with both mandatory health insurance (Social Security) and supplemental insurance (mutuals, insurance companies) involved in the process. In 2018, management fees for supplemental health insurance were around 20% of revenue, while Social Security’s management fees were 4%, even though Social Security covers 80% of health costs compared to only 13% covered by supplemental insurance. Integrating supplemental insurance into Social Security and fully covering a basket of preventative and solidarity-based healthcare services could save 7 billion euros in unnecessary management fees.
Advocates for a unified healthcare system (“la Grande Sécu”) suggest integrating mutuals into Social Security and providing 100% coverage for a basic package of healthcare services. This would eliminate the need for supplemental insurance for solidarity-based services, such as certain medications, comfort care, and specialist fees. This proposal was supported during Emmanuel Macron’s first term by various key figures in the healthcare sector, including Didier Tabuteau, Pierre Louis Bras, and Martin Hirsch. The goal is not to restrict access to long-term illnesses covered at 100%, as proposed by some, but to expand coverage.
Eliminating contributions to supplemental insurance, which continue to rise in cost, could allow for an increase in the general social contribution (CSG) or social security contributions, at a lower cost compared to what individuals currently pay for supplemental insurance. This approach would reduce unnecessary management fees, simplify the healthcare system, and ensure broader coverage for essential health services. Adopting a more unified approach to healthcare financing could lead to significant cost savings and more equitable access to healthcare for all citizens.
Overall, restructuring the healthcare financing system in France to integrate supplemental insurance into Social Security and expand coverage for essential services could lead to significant cost savings and a fairer, more efficient healthcare system. By reducing management fees and streamlining the healthcare process, the government could potentially improve access to quality healthcare for all citizens while also addressing the rising costs associated with supplemental insurance. This approach has been supported by key figures in the healthcare sector and could potentially lead to a more sustainable and equitable healthcare system in France.
