Key points
- France runs the Bismarck model: statutory health insurance through sickness funds, funded from payroll contributions.
- Statutory health insurance covers nearly the whole population, and most people also hold complementary insurance that pays the co-payments.
- Care is delivered by mostly private providers, regulated, with free choice of provider.
- Covered services carry co-payments, usually topped up by complementary insurance — the patient rarely pays the full co-payment.
- Life expectancy at birth was 83.0 years in 2023, and health spending was 11.5% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: France runs the Bismarck model: statutory health insurance through sickness funds, funded from payroll contributions, paying mostly private providers who are regulated. Statutory insurance covers nearly the whole population, and most people also hold complementary insurance that pays the co-payments the statutory scheme leaves. Covered services carry co-payments, usually topped up by complementary insurance. Life expectancy at birth was 83.0 years in 2023, and health spending was 11.5% of GDP in 2024 (OECD Health at a Glance 2025).
At a glance
| Item | Detail |
|---|---|
| Model | Bismarck — statutory health insurance |
| Who pays | Statutory health insurance via sickness funds, from payroll contributions |
| Who delivers | Mostly private providers, regulated; free choice of provider |
| What is free at the point of use | Covered services with co-payments, usually topped up by complementary insurance |
| Life expectancy at birth | 83.0 years (2023, OECD Health at a Glance 2025) |
| Health spending | 11.5% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | KFF Health Policy 101 — international comparison |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
France’s statutory health insurance — the Assurance Maladie — covers nearly the whole population. Workers and employers pay contributions into sickness funds, and the funds pay providers. The scheme is compulsory and universal in practice: residence in France brings coverage, and the small number of people outside the main scheme are covered by related schemes for specific occupations.
Care is delivered by mostly private providers: office-based physicians, private clinics and hospitals, and public hospitals that sit alongside them. Patients have free choice of provider, including specialists, though the system encourages a designated treating doctor — the médecin traitant — who coordinates care and whose referral gives better reimbursement. Hospitals are a mix of public and private; public hospitals are the largest providers of hospital care.
Who pays, and what people pay
The statutory scheme pays a set share of the fee for each service — typically around 70% for a consultation — and the patient pays the rest as a co-payment, called the ticket modérateur. Most people also hold complementary insurance, known as a mutuelle, usually through an employer or a mutual insurer, which pays the co-payment. The result is that the patient rarely pays the full co-payment out of pocket, though the two layers together still leave some services — dental, optical, some medicines — partly paid for by the patient. People on low incomes are covered by a public complementary scheme that removes the co-payment entirely.
What is free, and what is not
Nothing is free in the sense of the United Kingdom’s NHS: every covered service has a statutory share and a co-payment. What the two layers together deliver is care with little or no payment at the point of use for most people, most of the time — the co-payment is paid by the complementary insurer rather than the patient. What is not covered, or only partly, is the margin: some dental and optical care, some medicines, and fees above the statutory tariff charged by some specialists.
How it compares
France spends 11.5% of GDP on health — above the OECD average of 9.3% — and its life expectancy of 83.0 years is 1.9 years above the OECD average of 81.1 years (OECD Health at a Glance 2025). Its distinguishing feature in this set is the two-layer design: a universal statutory scheme plus near-universal complementary insurance, combining the Bismarck funding model with out-of-pocket costs that are low in practice. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Do French patients pay to see a doctor?
The statutory scheme pays most of the fee and the patient pays a co-payment, which complementary insurance usually covers. The patient rarely pays the full co-payment out of pocket.
What is complementary insurance?
Private insurance, usually through an employer or a mutual insurer, that pays the co-payments the statutory scheme leaves — for consultations, medicines, dental and optical care. Most people in France hold it.
Can French patients choose their own doctor?
Yes. Patients have free choice of provider, including specialists. A designated treating doctor coordinates care, and referral through that doctor gives better reimbursement.