Health — France · Synthesis

A life expectancy among the highest. Life expectancy at birth reaches around 82.8 years in 2024 (INSEE), among the highest in the Union (women ≈ 85.6 years, men ≈ 80.0 years). France stands out above all for a top-ranking female life expectancy. Healthy life expectancy (disability-free), on the other hand, is closer to the European average, around 65-67 years.

Health spending among the highest in the OECD. Current health expenditure represents around 11.9% of GDP (DREES/OECD, 2023), above the Union average and close to Germany. The share remaining payable by households (out-of-pocket) is one of the lowest in the OECD, thanks to coverage by the Assurance maladie and complementary insurers — a distinctive feature of the French model.

Infant mortality: a point of vigilance. Infant mortality stands at around 3.9 per 1,000 births (INSEE, 2023), a level that has stopped falling and places France above several European neighbours — an indicator closely tracked by Santé publique France and DREES, and debated with regard to perinatal organization.

Access to care: the question of "medical deserts." Medical density (≈ 3.3-3.4 doctors per 1,000 inhabitants) masks strong territorial disparities. Waiting times for access to a doctor (general practitioner as well as specialist) and the share of the population without a treating physician are at the heart of the debate. Reports from the Cour des comptes and DREES document a growing geographic inequality of access, despite a high overall number of professionals.

Hospital under strain. The number of hospital beds (≈ 5.7 per 1,000 inhabitants) has declined over the long term. Strains on human resources (emergency services, care staff), accentuated since the Covid crisis, dominate hospital news. The financial sustainability of the Assurance maladie (national spending target, ONDAM) is a recurring topic of the Social Security financing laws.

Medical demographics: the trough before the upturn. The end of the numerus clausus (replaced by the numerus apertus) will increase the number of doctors trained, but the effect will materialize only gradually over the decade. In the meantime, doctors' retirements and the ageing of the population maintain the strain on the supply of care.

Ageing and chronic diseases. The rise in long-term conditions (ALD) and demographic ageing structurally drive up health and long-term-care spending. Organizing the "shift to home care," prevention and care for the very elderly is a major undertaking (DREES, old-age / autonomy bills).

Prevention and health inequalities. France has historically invested more in curative than in preventive care. Santé publique France and HAS advocate strengthening prevention (tobacco, alcohol, obesity, mental health), where France retains room to improve, and reducing social and territorial health inequalities.

Financial sustainability of the Assurance maladie. The deficit of the health branch and the trajectory of the ONDAM place efficiency at the centre of the debate: relevance of procedures, shift to outpatient care, drug prices, city-hospital coordination. The Cour des comptes regularly calls for structural reforms rather than short-term savings.

The open questions. Three issues will shape the period: (1) guaranteeing access to care everywhere across the territory; (2) sustainably financing an ageing system without degrading quality; (3) reorienting towards prevention to gain years of healthy life, where the main margin for progress lies.

Placed in its environment, France shows leading health outcomes for high spending: the challenge is not the level of funding, already among the highest, but its efficiency and the equity of access.

Three takeaways. (1) Life expectancy: among the leaders. At ≈ 82.8 years, France sits among the best in the OECD, above Germany (≈ 81.2 years) and the United Kingdom (≈ 81.3 years), close to Italy (≈ 83.0 years) and Canada (≈ 82.6 years).

(2) Spending: among the highest. At ≈ 11.9% of GDP, France spends more than the Union average and than Italy, at a level close to Germany and Canada — with one of the lowest household out-of-pocket shares, a sign of a high socialization of health risk.

(3) Access and prevention: room for progress. Despite the spending, France is not the best placed on territorial access to care and on prevention (tobacco, obesity), areas where several European peers do better. This is where the potential for improvement at constant spending is concentrated.