France healthcare overview

France‘s health system is based on a two-tier health insurance system.

The healthcare spend is predominantly funded by mandatory public health insurance (57%) and voluntary private health insurance (26%), with the remainder from other state taxes (10%) and patient out-of-pocket payments (7%)[1].

All residents are required to pay approximately 8% of their salary into the statutory health insurance scheme (SHI), managed by the social security agency la Sécurité Sociale. Approximately 90% of the population also has additional (voluntary) private health insurance (from for-profit or not-for-profit companies) to cover the gap between point-of-use healthcare costs and the amount reimbursed by public health insurance.

Healthcare is governed centrally by the Ministry of Health and Prevention, which plays a strong role in organising the health system and determining the operating conditions. The central government sets the healthcare budget and controls the amount and direction of healthcare expenditure via la Sécurité Sociale.

The delivery of healthcare at a local level is managed by 18 Regional Health Agencies (ARS). Each ARS has a strategic health plan to allocate their healthcare budget to services that meet the needs of their population. In 2019, the largest category of healthcare spending was inpatient care in public and private hospitals (32%) and outpatient care in primary care centres, specialist services and dental care (28%)[1]. The ARSs created Regional Hospital Groups (Groupements Hospitaliers des Territoires - GHT) to integrate public health services within their regions.

The French health system is characterised by free choice of patients. GP referrals are the gateway to specialist care and patients (or their GP) can choose to refer to a public or private specialist. 

ARS’ play an important role in the availability and distribution of public and private services in their region through allocation of authorisations. ARS have a dual role as the local approval authority and regulator as well as managing the public hospitals. Delivery of any new clinical services and equipment (in hospitals and some outpatient services) must first be authorised by the ARS.  Authorisations are limited to enable the ARS to control the volume of clinical services offered in their region.

The National Authority for Health (HAS - Haute Autorité de Santé) accredits doctors to practice and independently certifies public and private hospitals against national clinical quality and safety criteria.

Each year, la Sécurité Sociale determines the national fixed fees for pharmaceuticals, primary, specialist, hospital and dental care.

Most healthcare services in France are reimbursed on a fee-for-service basis based on Diagnosis Related Group (DRG), however this is starting to change.

Both public and private providers are on a fee-for-service rate by the government, calculated by diagnosis, procedure or service. Patients accessing health services are reimbursed by their public health insurance fund between 80-100% of that national fee, regardless of whether they access services from a public or private provider. However, private doctors maycharge patients a higher fee than the state-determined rate. Hence, a large proportion of the population (approx. 90%) has additional private health insurance to cover any gap.

Doctors are categorised into three sectors that describe the fee-for-service they charge. Sector 1 doctors charge the national fixed fee and the patient will be reimbursed 80-100% of that fee each time they access the service.  Most GPs are in this category. Sector 2 doctors are approved to charge a higher rate with “reason”. Patients are reimbursed 80-100% of the national fixed fee and pay the gap using private health insurance or a self-funded co-payment. Most specialists are in this category. Sector 3 doctors have no fee limit. These are usually doctors practising in highly specialised areas of medicine.

Hospital fees (public and private) are set by the central government at a fixed rate per patient (based on DRG) to cover the fixed costs of clinical facilities, administration, nursing care and hotel services. Public hospitals are also paid per patient (by DRG) but at a rate 20% higher than the private hospitals. Public hospitals also receive additional dedicated funds for activities not directly related to individual health service delivery, such as research and training.

Private hospitals charge patients an additional fee if they choose to access a private room or extra hotel services, and this is usually covered by the patient’s private health insurance or self-funded. Private hospitals will also receive additional income from specialists who pay the hospital for use of their facilities (ie. theatres, consulting rooms) and for the provision of administrative services. This is a negotiated rate and based on a percentage of the specialist’s income and the level of additional services they access from the hospital (such as consultation rooms, administrative support etc.).

Mental health

The national government has introduced a value-based model in which healthcare providers are reimbursed based on the value they provide to patients, rather than the volume of services they provide.

Mental health services (from 2022) and Rehabilitation services (from 2023) are funded using a tiered fee structure based on day-rate, population allocation (based on socio-economic status and patient acuity within that region) and quality outcomes (reported patient clinical outcomes and experience). 

Providers of healthcare services

Specialist consultants in France are either self-employed and consult at the private hospitals or work in the public system. They very rarely work at both, although many self-employed specialists may work for a number of different private providers. Patients require a referral from their GP to access specialist services. 

The majority of specialists working at Ramsay Santé facilities are self-employed, with the exception of rehabilitation physicians and some psychiatrists. Self-employed specialists are paid directly by the government or by the patient (who will be reimbursed). Specialists must be authorised to practice at each Ramsay Santé hospital by the hospital clinical administration. 

[1] OECD State of Health in the EU-Country Health Profiles – France 2021


The information in the ‘Our markets’ section of the Ramsay Group’s website is based on information obtained from external sources and is current as at 16 February 2023. Ramsay has not independently verified the information presented in this section. The information is in summary form and is not necessarily complete.

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