France considers linking health reimbursements to income to curb deficit

The French government is considering whether to make health reimbursements based on patients’ income, after such a system was recommended by supreme auditing court la Cour des comptes.

The plans could help the government shore up the social security (Assurance maladie) deficit, as it looks to save billions in public funds. As of 2024, the deficit was €15.3 billion (€4.5 billion more than in 2023).

Hedwige Chevrillon, at BFMTV, summarised: “The French are champions when it comes to medicine consumption. [We consume] 41 boxes per year, other countries are at much lower levels.” 

The Cour des comptes made the recommendations in its most recent report. It said that the Assurance maladie could save money by:

• Working more effectively against claim fraud

• Asking taxpayers to pay more tax contributions towards healthcare reimbursements

• Rethinking the reimbursement system overall, taking patients’ income into account.

This is not a new idea; paying reimbursements based on patient income is already the case in Germany. 

The suggestion comes five months after then-Health Minister Geneviève Darrieussecq proposed another money-saving plan, in which the state would reduce its reimbursement of medication and medical consultations by 5%, with the shortfall made up by patients or their private insurance policies.

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‘We’re not going to have a carte Vitale Gold’ 

Yet, Philippe Besset, president of pharmaceutical union la Fédération des syndicats pharmaceutiques de France, was against the new idea. He told BFMTV: “The richest people already pay more than the poorest, it’s not practical.

“We are not going to have a carte Vitale ‘Gold’, or a carte Vitale for those who don’t pay. We have a real social security system in France.”

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When BFMTV asked some pharmacy customers their views on the idea, it also appeared controversial.

One said: “I think that sounds pretty fair,” while another said: “I wouldn’t be completely in agreement if only a certain category of people had to pay.” Another said: “People who earn more deserve to do so, so I don’t see why we should penalise them.”