Is France's system still one of the best in the world?

France is among the countries with the highest life expectancy and is often seen as having one of the best health systems. It is also among those with the least out-of-pocket healthcare costs for residents. Americans, in particular, regularly cite the good access to healthcare as a major reason for moving to France.

The World Health Organization (WHO) stated France to have overall the best system in the world in a 2000 study, but this study has not been repeated since then. Even so, the latest available WHO health statistics (using 2021 data) show that ‘healthy life expectancy’ (number of years in good health) in France is on average 70.1, compared to 66 in Europe generally, 63.9 in the US and 68.6 in the UK.

Total life expectancy at birth in France (as opposed to ‘healthy’ life expectancy) is 81.9 (79.1 for men and 84.7 for women) according to WHO data and even higher according to the OECD group of developed countries, likely to be due to slight differences in how each body compiles and analyses the data.

A study by French state research body Drees found that compared to other OECD countries with similar systems (where the majority of healthcare is covered by state-sector funds), France was top along with Luxembourg for the lowest out-of-pocket costs once state reimbursement plus local authority aids and top-up health insurance policies are factored in. 

It found that, on average, 8.7% of costs related to healthcare and medicines had to be borne by patients themselves, compared to a European average of 14.4%.

While all is not perfect and, like many countries, France faces an aging population and competing priorities for public funds, it continues to make significant investments into its health system. 

The financial burden of the system on its population is among the most well-balanced and widely distributed across income brackets and it is accessible to its most vulnerable population groups.

Recent reforms have generally expanded access to under-served populations, including to older and disabled people, and France is responding well to opportunities afforded by new digital technologies. Medical equipment such as hearing aids, dentures and glasses have been better-funded under the state system and now benefit from near-complete coverage. 

Reforms have also aimed to better tackle chronic diseases such as cancer, as well as to simplify administrative procedures to make the reimbursement of out-of-pocket expenses easier and, in certain cases, to abolish the requirement for advance payment.

Comparison of people's health with other OECD countries

To further examine France's position in terms of healthcare performance, we have compiled three tables using data from the OECD's latest (2023) Health at a Glance report. The charts measure population health status and access to care. They also look at quality of care. They are mostly based on figures from 2021. We note, however, that some of the data appears atypical, probably due to the influence of the Covid pandemic, and in some cases data is lacking, likely again for the same reason.

Life expectancy in France compared with UK, US and other OECD countries

Life expectancy is a measure of how long, on average, a newborn can expect to live. Eating habits, lifestyle and genetics play a role, however, healthcare is clearly significant. 

People in France are some of the longest-living people among the OECD countries, ahead of the UK, US and the general average. The OECD's report gave a French average of 82.4. Japan is the best, and Latvia the worst, in the OECD.

The yearly number of 'avoidable' deaths per 100,000 inhabitants, referring to deaths which should, in theory, have been avoided if everyone had received high quality care is also favourable (though, in general, this had worsened compared to pre-Covid). For France, this was 160 compared to 237 on average.

The prevalence of diabetes as an indicator of chronic disease is also much lower than that of most other countries. The proportion of people who are unhappy with their health is higher in France than in most countries. 

However this is subjective and may reflect socio-cultural differences as well as the number of older people and differences in survey design, states the OECD. 

There may be some truth to the stereotype that the French like to complain, whereas Americans try to think positive.

Access to care in France compared with UK, US and other OECD countries

Most OECD countries have state healthcare cover, and France virtually ties with the UK for nearly universal coverage. French people, however, report being slightly less satisfied with health coverage than Americans, but this may be cultural, as many American expatriates report easier, less expensive access to healthcare as among elements they enjoy.

The percentage of people's total medical expenditures covered by state or 'other compulsory' schemes is also high in France, but it is important to note that these figures hide significant differences. 

The French system is mostly covered by the state (notably from obligatory social charges on work), plus a smaller amount from individual 'top-up' policies subject to regulations limiting their cost, which employers must part-fund.

In comparison, the UK's NHS promises to cover all essential needs via the state, but this can involve significant waiting times. It also has a costly fully-private sector. In the US, about 19% of low-income people qualify for basic state 'Medicaid', whereas most people have private policies. Larger firms must part-fund these. 

An Obama-era law made it illegal not to have health insurance, and although the associated fines were abolished from 2019, certain states have their own laws – and fines – requiring it.

Only 2.8% of the French population report 'unmet needs' (whether they ever, in the last 12 months, felt they needed medical care they did not receive), which is considered a little above the OECD average. No statistics are available for the UK and US on this.

Quality of care in France compared with UK, US and other OECD countries

There are many different ways to measure the quality of care objectively, and these may be measured in primary or secondary healthcare settings.

The number of prescriptions for antibiotics is significantly higher in France than the OECD average, although it has dropped over the last few years. Overprescription of drugs is one criticism sometimes aimed at France, but is likely in part due to the cultural setting of French patients' expectation that they should always leave with a treatment.

"Avoidable hospital admissions" relates to situations where a patient was treated in hospital where their condition could have been dealt with in primary care (such as a GP surgery). Inexplicably, the OECD had only very old (2014–15) data from France on this for its latest report.

Positive outcomes following a heart attack and stroke were better in France than the OECD average or in the UK.