Tribune. For thirty years, France has been in the leading group of the four countries spending the most in health (with the United States, Germany and Switzerland), where we spend one to two points of GDP of more than the average for OECD countries. During the 2010s, before the Covid-19 crisis, the share of our national wealth devoted to all health spending (public and private) always exceeded 11% of GDP, far behind the United States ( 17% of GDP) but neck and neck with Germany and Switzerland, ahead of Japan and Sweden, then the other Nordic countries, southern European countries or Great Britain (which are between 9 and 10% of GDP depending on the year).
Contrary to popular belief, competition between insurance companies and between health professionals, far from lowering costs, tends, on the contrary, to increase them. Health expenditure is higher where competition between doctors and between insurance companies is greatest. In countries where national health systems operate as a public service (Great Britain, Nordic countries, Southern Europe), public authorities pay professionals directly in the form of salaries or in proportion to the size of their patient population, their installation and practices as well as those of patients. Spending is lower there than in health insurance systems (private in the United States or Switzerland, collective and compulsory in Germany, Japan and France), where professionals are paid on a fee-for-service basis and retain a large autonomy of installation, pricing and prescription vis-à-vis the public authorities, just as patients retain great freedom of choice of doctors or hospitals.
France, champion of spending
Who pays for these expenses? The share of private spending is higher in health insurance systems (between 25 and 35% of total expenditure in Europe, 50% in the United States) than in national health systems (less than 20% in Great Britain and less than 15% in the Nordic countries). In France, social security coverage has recently improved to around 78% of expenditure. Social security assumes the costs of hospital care and long-term illnesses, but much less well for day-to-day care, leaving mutuals 21.5% of the cost of city medicine and 12.4% of the price of drugs; the patients themselves must bear 10.3% and 11.8% of these costs, respectively (data for 2019).
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