Financial burden of health payments in France: 1995 – 2006

The objective of this paper is to study the financial burden of health payments and their determinants in France applying a catastrophic health expenditure methodology (i.e. health payments that equal or exceed a threshold of household’s capacity to pay). An analysis of the progressivity of health insurance contributions and out-of-pocket payments is also carried out using progressivity indexes.
Using French household budget surveys from 1995, 2001 and 2006, we find that the proportion of health payments in the total expenditure of households has decreased on average from 5.2% in 1995 to 4.2% in 2001 and to 3.3% in 2006. A few households faced high burden health expenditure, i.e. health expenditure that exceed 25% of their capacity to pay (5.9% in 1995, 3.8% in 2001 and 2.6% in 2006), but most of them were in the richest quintile.
In French health financing system where basic service package is covered by public insurance, the voluntary based private health insurance significantly reduces the incidence of high burden expenditure and contributes to improving financial protection. In contrast, it does not add to the equity in health financing as private insurance contributions are regressive.