President Sarkozy has announced that the private health insurers must assume greater responsibility for meeting the costs of the French health system.

In a speech to the annual meeting of the health insurers last month, the President stated that the demands on the health service were outstripping the capacity of the state to fund it.

‘The growth in our economy, even when the economic crisis ends, will not permit the social security system to fund all our needs’, he stated. ‘The system of national solidarity cannot finance everything. We need to make a choice’.

The conclusion appears to be to redraw the lines of responsibility between the health insurers and the state.

Whilst the state funds around 70% of the costs of health treatment in France, the rest is borne by the complementary insurers and patients themselves.

Within this broad generalisation, there are varying levels of cover, with most major illnesses covered 100% by the state, whilst dental and optical treatment is often poorly reimbursed.

In his speech President Sarkozy proposed a transfer to the private insurers of some of the cost of the treatment of major illnesses, such as cancer, high blood pressure and diabetes.

Around 8 million people in France (14% of patients) suffer from a major illness (Affection de Longue Durée - ALD), accounting for two-thirds of the expenditure of the health system.

The insurers are also being asked to pick up a larger proportion of dental and optical treatment, as well as the excess charges imposed by some health specialists, which are currently not reimbursed by the state, and only rarely accepted by the insurers.

The new proposed ‘partnership’ was welcomed by the insurers, probably in the full knowledge that if they did not accept it, it was likely they would face an increase in the tax on their activities, as occurred earlier in the year!

The health insurers in France comprise a large number of ‘mutual’ organisations, as well as the mainstream private insurance companies. Together they currently fund around 12% of health service costs, from insurance contributions made by their policy holders.

Around 85% of French inhabitants hold a top-up’ health insurance policy from one of the insurers, either through an individual or work based collective policy.

The annual cover for a couple in their fifties costs anything from around €1000 to €3000 per year, depending on the level of the cover.

No-one is too surprised at the proposal made by the President, as the state health insurance fund has a chronic and growing deficit, and during his election campaign in 2007, Nicolas Sarkozy made no secret of his belief that a greater proportion of the costs needed to be borne by patients, either directly, or through the complementary health insurance system.

In recent years, the mutual health insurers have already started to take a larger role in the health service. Not only do they provide complementary health cover, but they also own and manage around 100 hospitals, 60 pharmacies, and several hundred dental and optical practices.

In 2008, they also established a new fund for the acquisition of private hospitals in France, a large number of which are in financial difficulties.

You can read more in our comprehensive Guide to the French Health Care System