Head To Head

Could private top-up insurance help fund the NHS?

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5424 (Published 12 October 2016) Cite this as: BMJ 2016;355:i5424

NHS Funding Options: emulate the French system?

Health care in France is funded primarily by Social Insurance. For serious conditions and for the disadvantaged the costs of care are fully reimbursed. For minor conditions the more affluent face patient charges for part of the cost. Most French citizens meet these charges with private insurance.

French Social Insurance, like UK National Insurance, is a proportional tax used to fund health care on an annual pay as you go basis. It exploits fiscal illusion created by mischievous use of the word “insurance”.

Requiring French patients to pay charges for relatively minor ailments was supposed to reduce patient utilisation. There is no evidence it does this largely because 95 percent users buy private insurance.

The fragmented French funding system creates complex bureaucracy and high administrative costs. It privatises part of the cost of care and offers poorer macro expenditure control compared to a single payment system such as the NHS.

As ever a single payer, tax financed health care system like the NHS offers greater efficiency and equity.

Competing interests: No competing interests

14 October 2016
Professor emeritus Alan Maynard
health economist
University of York