France is a far healthier country than America - Yet even its medical care is under strain – The Economist – 24.04.25
- Michael Julien
- Apr 25
- 5 min read
France spends less of its national income on health care than America, but is by most measures a lot healthier. Its total health expenditure, at 12.1% of GDP, is well below the 16.6% in America. Yet the French live on average six years longer than Americans. France’s mortality rate from heart attacks is a third of America’s, its obesity rate is about a third as high, and its rate of opioid-linked deaths a tiny fraction.
France outperforms its European peers on many measures too. It has a lower mortality rate from breast cancer than Britain and Germany. Life expectancy at the age of 65 is higher than in any other EU country bar Spain, which it equals. France also has the best survival rate following a heart attack of any OECD country after Japan and South Korea, tied with the Netherlands.
How does France do it? Part of the explanation is cultural habits. Indeed lifestyle, suggests Gaetan Lafortune, an OECD health economist, is more important in explaining France’s long life expectancy than its big government health budgets. In French state schools even tiny children sit down to a three-course meal.
A recent menu in primary schools in Seine-Saint-Denis, a run-down suburb of Paris, includes vegetable soup, cod fillet with peas, and fresh fruit; chips are served only once during a month. In America up to 17% of the population lives in “food deserts”, with limited or no access to fresh produce. A researcher in France in 2021 found that the concept did not really exist.
Comprehensive state-mandated health coverage is another factor. The French system is a mix of national public health insurance, which reimburses patients for on average 70% of medical bills, and private mutual health insurance, which covers most of the balance.
Employers have to provide this top-up insurance to their employees. The self-employed and pensioners buy their own policies. They cost on average €1,540 ($1,745) a year for a family, far less than the figure of $25,570 in America. The state covers those on low incomes.
Medical costs, meanwhile, are controlled through government caps on the fees charged by most family doctors, who are self-employed, as well as on the contracted private hospitals that provide 35% of hospital care. The share of health-care bills that families have to pay from their own pockets amounts to an average of just 2% of household spending in France. This is lower than in Britain (2.5%) despite its free-to-use National Health Service.
The hybrid French state system also helps patients get thorough treatment. France conducts twice as many CT, PET or MRI scans per person, for instance, as Britain. Appointments are not rationed by top-down bureaucracy. Thanks to a tech start-up called Doctolib, which 50m French patients use each year, appointments for most GPs, specialists and labs can be booked online with a few clicks.
The trouble with all this is that it comes at a cost. Total health spending in France, at €266bn, is higher as a share of GDP (12.1%) than in any other OECD country apart from America and Germany. Even when pandemic-linked spending is stripped out, French public health expenditure outpaced inflation from 2019 to 2025. Yet France’s finance minister, Eric Lombard, says he now needs to find €40bn of overall public-sector savings, some of it from health, to curb the country’s deficit to a still-hefty 4.6% of GDP in 2026.
This new pressure comes at a time when the health system already faces a triple squeeze. The first is due to a shortage of younger doctors. For decades the government capped the number of medical students. President Emmanuel Macron abolished the rule in 2019. But it will take a decade for numbers to recover. Nearly a third of GPs in France are aged over 60. Retiring GPs struggle to find younger doctors to take over their surgeries. A GP near Paris, aged 70, says he returned from retirement to consult part-time to help patients.
This shortage has exacerbated a second problem: overloaded hospital emergency services. France has more hospital beds and intensive-care beds per person than the OECD average. But in recent years it has been closing beds, as part of a strategy to rationalise hospitals and shift the focus to day surgery. Yet the number of patients turning up at emergency services has soared.
Between 1996 and 2023 the yearly number of visits to accident and emergency doubled, from 10.1m to 20.9m. Moreover, 72% were “not very serious or urgent”, noted a report by the Cour des Comptes, the national auditor, in 2024. Some hospital doctors have gone on strike in protest. In February emergency doctors at Perpignan public hospital denounced an overload that was “more than critical”, saying that they could no longer staff shifts fully.
A third difficulty is “medical deserts”. Doctors tend to choose to live in big cities, cobbled towns and coastal resorts, leaving the rural interior without decent cover. Waiting times to see an ophthalmologist, for instance, vary from six days in some areas to 123 days in others, according to a Senate report in 2024.
The government is offering sign-up bonuses to encourage doctors to move to unpopular areas. Some village mayors and big public hospitals, including one in a rough neighbourhood of Marseille, have provided surgery premises to lure GPs. But France’s patchy medical geography is proving hard to shift.
Mindful of these problems, the government is trying to ease the pressures, as well as to cut waste. Catherine Vautrin, the health minister, has just tightened the rules, for instance, on prescriptions for reimbursed sticking plasters, in order to save on the €740m it spends a year merely on this. But such sums are trifling next to the overall health budget. Old habits are resistant.
The French remain enthusiastic pill-poppers; their doctors still prescribe more antibiotics than those elsewhere. France, notes the Cour des Comptes sternly, “is one of the last OECD countries to reimburse thermal spa treatments with no medical benefit proven”—and this to the tune of €250m in 2023.
In some ways France’s health system is a victim of its success. “Because of the very good historical indicators, and the sense that France has been one of the best health systems in the world, these new pressures come as a shock,” says Francesca Colombo, head of the OECD’s health division. Accustomed to excellence, the country expects it—and is ill-prepared for the upcoming budget squeeze on waste and excess that is needed to keep it that way. ■
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