Strengthening health systems for equality

Strengthening health systems for equality

As an established advocate for universal health coverage, France has implemented several leading initiatives to increase health provisions, while minimising costs

By Agnès Buzyn, Minister of Solidarity and Health, France


Strong health systems can only be achieved with better access to high-quality health services for all, without financial hardship or risk of impoverishment. That is the aim of achieving universal health coverage, a sustainable solution that takes full account of the economic and social aspects of reinforcing health systems and that contributes to their resilience when faced with pandemics and health crises.

Significant inequalities persist worldwide between countries, as well as between populations, depending on gender and geographical, social, environmental and health conditions. In many developing countries, a fragile healthcare system is one of the main obstacles to accessing vital treatment. Furthermore, in some developed countries, even today, a large section of the population has no guaranteed access to health care.

Given ageing populations and the growing burden of chronic diseases – and also the rise in health spending, shortages in the healthcare workforce and the persistence of health inequalities – policies to achieve universal health coverage need to become more multifaceted and widespread throughout health systems. They need to target inpatient and outpatient care, leverage new digital technology opportunities, and involve patients and service users. Implementing transversal and cross-sectorial action is now a priority for policymakers at the national level, as well as for the international community, including civil society, at the global level.

Since 1945, France has made the choice of promoting solidarity and equality as core values of its French social model, basing provision of health care on a compulsory social insurance system funded by social contributions, co-administered by workers’ and employers’ organisations under state national regulation, and driven by redistributive financial transfers.
Currently more than 95% of the population is covered by national health insurance. Out-of-pocket fees – around 7% – are among the lowest among the countries in the Organisation for Economic Co-operation and Development.

Nonetheless, sustainable performance improvements remain a concern for successive French governments. Through the current policy reform Ma Santé 2022, which I have been leading along with President Emmanuel Macron since September 2018, priority is now given to shaping new synergies among all professionals whether they practice within hospitals or medico-social systems or outside of those systems. The model of financing is also revised, especially through 100% Health Reform, which aims to reduce out-of-pocket payments.

Innovative measures have also been implemented for guaranteeing better prevention and access to quality health care for all, developing multisectoral prevention policies (targeting non-communicable diseases, as well as risk factors and social and environmental determinants of health), and strengthening the primary healthcare system. Ma Santé 2022 proposes the creation of a real healthcare project in each territory that brings together all hospital, non-hospital and medico-social health professionals. Doctors, pharmacists, nurses and physiotherapists must pool their skills and resources to serve the  health of patients within their territory and create a healthcare collective at the service of patients.

At the international level, France has been advocating universal health coverage for years to all international organisations, especially the World Health Organization. This commitment culminated in September 2015 with the adoption by the international community of universal health coverage as one of the targets of the Sustainable Development Goals. Moreover, France has made it a guiding principle of its Global Health Strategy 2017–2021. In particular, France is supporting joint initiatives for developing countries, particularly in Africa, to implement universal health coverage, notably for vulnerable populations, such as for improving maternal and child health.

More recently, under the 2019 French presidency, the G7 has recognised that progress was still needed globally in reinforcing primary health care to combat health inequalities. Indeed, health promotion, prevention, treatment, immunisation and nutrition, as well as health literacy, can lead to significant advances in health, stability and socio-economic development.

Furthermore, ending the three epidemics of AIDS, tuberculosis and malaria, achieving universal health coverage and the SDGs related to health by 2030, and improving global health security, will not be possible without a mix of financing sources. That is why the G7 has committed to support the success of the Sixth Replenishment Conference of the Global Fund, which France will host in Lyon on 10 October 2019.

Forty years after the global commitment of Alma-Aty, in October 2018 the new declaration of Astana renewed the political commitment to primary health care of governments, non-governmental organisations, professional organisations, academics, and global health and development organisations. Today, this approach deserves to be fully implemented. In particular, there is now momentum to improve coordination of knowledge on primary health care, facilitate its use by policymakers and share experiences on primary healthcare implementation.

France is leading the G7 Primary Health Care Universal Knowledge Initiative to explore options for a web-based knowledge-sharing platform. It will allow gathering and coordinating existing expertise, and encouraging cross-country learning on primary health systems among interested countries for mutual benefits. The WHO, OECD, World Bank Group, Global Fund and Gavi, the Vaccine Alliance, will work together for improving coordination towards achieving SDG 3 for good health and well-being, notably under the framework of the Global Action Plan for Healthy Lives and Well-being for All.