France devotes fewer means to Health than the United States, but according to most indicators, it is much better. Its total health expenses, which represent 12.1 % of GDP, is much lower than 16.6 % of the United States. However, the French live on average six years more than the Americans. The mortality rate per heart attack in France is three times lower than in the United States, ditto for the obesity rate; As for the risk of dying because of opiates, it is tiny.
No “food desert” in France
France also surpasses its European counterparts in many respects. It displays a mortality rate by breast cancer lower than that of Great Britain and Germany. Life expectancy at 65 is higher than in all other EU countries, with the exception of Spain, a country with which it is equally. France also displays the best survival rate after a heart attack from all OECD countries, just behind Japan and South Korea, and tied with the Netherlands.
The lifestyle counts more than the high budgets of the state dedicated to health to explain the longest life expectancy of the French.
How does France get there? Part of the explanation lies in its cultural habits. Indeed, according to Gaetan Lafortune, an OECD health economist, the lifestyle counts more than the high budgets of the state dedicated to health to explain the longest life expectancy of the French. In French public schools, even the youngest children sit down to have a meal made up of three dishes. Let us take, for example, a recent menu in primary schools in Seine-Saint-Denis, a disadvantaged suburb of Paris: it includes a vegetable soup, a cod net accompanied by peas and fresh fruit; There are fries there only once a month. In the United States, up to 17 % of the population lives in “food deserts”, with limited or non-existent access to fresh products. A French researcher noted in 2021 that this concept does not really exist in France.
Hybrid health coverage but costly for the state
The full health coverage imposed by the State is another explanatory factor. The French system is based on both national public health insurance, which reimburses an average of 70 % of medical costs to patients, and shared private health insurance, which covers most of the rest. Employers must provide this additional insurance to their employees. The self -employed and retired workers subscribe to theirs. A mutual insurance company costs an average of 1,540 euros ($ 1,745) per year for a family, much less than the 22,500 euros (25,570 dollars) practiced in the United States. As for low -income people, their health expenses are taken care of by the state.
A mutual insurance company costs an average of 1,540 euros per year for a family, much less than the 22,500 euros practiced in the United States.
Medical costs are under control thanks to the establishment of ceilings set by the government for the fees of most general practitioners, who are independent, as well as for private hospitals which provide 35 % of hospital care. The share of health costs that families must pay from their pocket represents on average only 2 % of household expenditure in France. This figure is lower than that of Great Britain (2.5 %), despite its free public health system.
This hybrid system also helps French patients to benefit from complete treatments. France produces for example twice as many scanners, TEP or MRI per capita as Britain. The meetings are not rationed by a centralized bureaucracy. Thanks to the Tech Doctolib start-up, used each year by 50 million French patients, it is possible to make an appointment online in a few clicks in most general practitioners, specialists and laboratories.
The problem is that all this has a cost. Total health expenses in France, which amount to 266 billion euros, represent a share of GDP (12.1 %) higher than in any other OECD country, with the exception of the United States and Germany. Even by excluding expenditure linked to the pandemic, public health spending in France exceeded inflation between 2019 and 2025. However, the French Minister of Finance, Éric Lombard, says that it is now necessary to achieve 40 billion euros in savings in the public sector, including a party in health, in order to bring the country’s deficit to a level, still too high, of 4.6 % of GDP in 2026.
-Shortage of doctors and emergency overload
This new pressure comes while the health system is already faced with a triple constraint. The first is due to a shortage of young doctors. For decades, the government has capped the number of medical students. President Emmanuel Macron abolished this rule in 2019. But it will take a decade for the workforce to be recovered. Almost a third of general practitioners in France are over 60 years old. Those who retirement find it difficult to find young people to resume their office. A 70 -year -old general practitioner near Paris explains that he came out of his retirement to exercise part -time to help his patients.
Between 1996 and 2023, the annual number of emergency visits doubled, from 10.1 million to 20.9 million. 72 % of them were “neither very serious nor urgent”, according to the Court of Auditors.
This shortage exacerbated a second problem: the overload of the emergency services of hospitals. France has more hospitals and intensive care beds per capita than the average of the OECD. But in recent years, it has removed beds as part of a strategy aimed at rationalizing hospitals and favoring ambulatory surgery. However, the number of patients in the emergency room exploded. Between 1996 and 2023, the annual number of emergency visits doubled, from 10.1 million to 20.9 million. In addition, 72 % of them were “neither very serious nor urgent”, according to a report by the Court of Auditors, the national organization of control of public finances, published in 2024. Some hospital doctors fell on strike to protest. In February, the emergency artists at the Perpignan public hospital denounced a “more than critical” overload, saying that they lacked staff to train complete teams.
Medical deserts and waste
The third difficulty is that of “medical deserts”. Doctors tend to choose to settle in metropolises, charming cities and in seaside resorts, leaving the interior of the country, more rural, without decent medical coverage. Waiting times to consult an ophthalmologist, for example, vary from six days in certain regions to 123 days in others, according to a report by the Senate of 2024. The government offers bonuses to encourage doctors to settle in poorly prized areas. Some mayors of villages and large public hospitals, one of which is in a difficult district of Marseille, have made available to premises to attract general practitioners. But the fragmented medical geography of France is difficult to modify.
France, notes the Court of Auditors, “is one of the last OECD countries to reimburse thermal cures without proven medical profit”, for an amount of 250 million euros in 2023.
Aware of these problems, the government is trying to lighten pressure and reduce waste. Catherine Vautrin, Minister of Health, has just strengthened the rules relating to the prescription of dressings reimbursed by Social Security [la prescription est désormais limitée à 7 jours, mais renouvelable, ndt]to save the 740 million euros spent each year on this title. But these sums are derisory in relation to the overall health budget. Old habits have a hard life. The French remain fervent consumers of medication; Their doctors always prescribe more antibiotics than their foreign counterparts. France, severely notes the Court of Auditors, “is one of the last OECD countries to reimburse thermal cures without proven medical profit”, for an amount of 250 million euros in 2023.
Victim of his success
In a way, the French health system is the victim of its success. “Due to the very good historical indicators and the feeling that France has one of the best health systems in the world, these new pressures have the effect of a shock,” explains Francesca Colombo, head of the OECD health division. Accustomed to excellence, the country expected it to be maintained and it is poorly prepared for future budgetary restrictions, necessary to fight against waste and abuse.
The Economist
© 2025 The Economist Newspaper Limited. All Rights Reserved. Source The Economist, Translation Le Nouvel Economiste, published under license. The article in original version: www.economist.com.
