How Did France Progess to Universal Health Care?
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Social Insurance, Pre-World War II
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France instituted its first social insurance program in 1930 with a Medicare-style program for wage-earning workers. French trade unions pushed for this program, which was funded by payroll deductions. The program did not apply to white-collar workers or those employed in agriculture. By the outbreak of World War II in 1939, this system covered two-thirds of the French population, according to a report by the World Health Organization, which in 2004 rated France's health care system the best in the world. The U.S., by contrast, ranked 37, behind most of Europe, as well as Morocco, Oman and Costa Rica.
The System's Beginnings
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In 1945, after World War II, France began the health care system in place today. The government instituted Securite Sociale (Social Security) as a health care and pension program. A centerpiece of the program is fee-for-service, in which physicians receive payment from patients, who then receive reimbursement from the government-administered insurance fund. Payroll deductions of 16 percent (10 percent paid by employers and 6 percent paid by workers themselves) funded Securite Sociale. The deduction has since risen to 20 percent (13 percent from employers and 7 percent from workers).
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Program Expansion
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Because post-World War II France made reconstruction of the country a priority, its Social Security program initially applied to wage earners and their families. Although universal coverage was a founding principle, this occurred only in stages. In 1961, coverage extended to farmers and agricultural workers. In 1966, the program extended to self-employed, non-agricultural workers.
A key reform in the 1960s involved pressuring French physicians to accept a uniform fee schedule. President Charles de Gaulle intervened personally to push for the schedule. De Gaulle appealed to patriotism, saying, "I saved France on a colonel's salary!" France's doctors agreed to the fee schedule.
Achieving Universal Coverage
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The program expanded even further in 1974, to cover individuals who did not fall into one of the aforementioned categories. However, some segments of the French population remained uncovered by Social Security. France instituted reforms in the 1980s to address the issue of coverage for the unemployed.
In January 2000, France's universal health care coverage act went into effect, establishing health coverage as a right for all legal residents. Those with very low incomes receive free coverage under the system.
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