Assurance maladie : soins de court terme et traitement à long terme

Health spending as a share of GDP stands in France at the average level of industrial economies and much below than in the US. Recently, spending has rapidly accelerated leading to a rise in public health insurance accounts deficits. This paper analyses the factors behind these changes: ageing populations, rising incomes boosting the demand for high quality health care, medical progress. At the macro level the future increases in social contributions that will be needed to balance health accounts should be planned. But reforms are also needed at the micro level to improve the efficiency of the health care system. The reform decided in 2004 introduces some elements of managed care (computerised medical records; referent doctor in charge of care coordination) but does not alter the core structure of a system that performs well for the majority of the French.