The Future of Sickness Insurance: A Major Political Issue for France

In 2011, as in every year for almost a decade, the French social security system (which covers four major types of risk: family, occupational accidents and illnesses, old age and sickness) will be in deficit with a “hole” of some 23 billion euros in its finances. This is less than was originally expected by the French government, but it undoubtedly means some new economy measures will be implemented. Among measures announced by the government at the end of September was a plan to save 2.5 billion euros from the sickness insurance scheme (where the deficit should be in the region of 12 billion euros). This is the last in a long line of plans that have begun to change the face of the French health system, with potential consequences for the fundamental principles governing sickness insurance. In this article, Didier Tabuteau, a specialist in health and social security matters, outlines the major recent trends in the field of sickness insurance in France, the future prospects for the system and the consequences that may ensue for citizens. He begins by reminding us of the paradigm shift that has occurred, largely as a result of globalization, which has gradually reinforced the pressure towards privatization of the system and impelled the players in sickness insurance towards change. He then shows the extent to which the foundations of “French-style” sickness insurance are under threat today, for example through the trend towards putting greater responsibility on the insured parties, which tends to delay access to care for poorer individuals, or through the questioning of the principle of solidarity (with a progressive slide from social cover to supplementary health insurance), though such solidarity is crucial to the system. Such developments have a considerable impact and could radically change the face of social protection in health matters. They cannot, therefore, argues Didier Tabuteau, take place without a broad democratic political debate that analyses the challenges in the health sector and the ways of dealing with them without sacrificing the social contract that currently exists in France.