Health expenditure in 2023 – Results of the health accounts – Edition 2024

Published on 2025-01-09

Mathilde Didier, Geoffrey Lefebvre (dir.)
The French Department of Research, Studies, Evaluation and Statistics (DREES) publishes ‘Health expenditure in 2023’. This panorama presents the health accounts, that quantify all health expenditure at the national level, analyses their results in 2023, and places them in an international perspective.

 

The current health expenditure (CHE) rises by 3.5% in France in 2023, reaching €325 billion. It is driven by a sharp increase in the consumption of healthcare and medical goods (CHMG), up by 5.2%, and in the long-term care expenditure (+6,2%), these increases offsetting the fall in prevention expenditure (-38.3%).

The year 2023 marks a return to normal after the health crisis, with most of the exceptional expenditure linked to Covid-19 coming to an end. Prevention expenditure thus falls back to €7.5 billion, a level close to 2019 (€5.7 billion in 2019), and much lower than the €16.5 billion peak reached in 2021 at the height of the crisis. This is the consequence of the sharp fall in screening and vaccination expenditure.

The consumption of healthcare and medical goods (CHMG) remains in 2021 more dynamic than before the crisis. It accelerates, driven by the consumption of hospital care (+5.7%), ambulatory care (+5.7%) and medicines (+3.1%). Hospital care expenditure reaches €122 billion, that is 49% of the CHMG. This share has increased since the crisis (in 2019, hospital care expenditure accounted for 47% of the CHMG).

The dynamics of hospital care are not the same in the public and private sectors. In public hospitals, healthcare prices increase by 3.6%, while in private clinics, they increase by just 0.4%. This is the consequence of a further sharp rise in public hospital pay in 2023, notably with the revaluation of the index point in July 2023, but also the increase in on-call allowances and the flat-rate hardship allowance. The pass-through in 2023 of the energy prices increases that occurred in 2022 contributes to the rise in prices in the public sector. In the private sector, the rise in energy prices does not translate into an increase in healthcare prices. As a result, in volume, health expenditure rises sharply in the private sector (+6.3%), much less so in the public sector (+1.8%). The dynamism of hospital care in private clinics is confirmed in 2023: the volume of activity is 16% higher than in 2019. In public hospitals, the volume of activity remains 5% below its 2019 level.

The consumption of ambulatory care amounts to € 72 billion euros, up by 5.7% compared with 2022. It is driven by medical specialists’ care (+6.6%), which has been on an upward trend since 2019: it has increased by 18.5% between 2019 and 2023. By way of comparison, consumption of general practitioners’ care rose by just 3.4% over the same period.

The consumption of ambulatory care is also boosted by the increase in consumption of healthcare provided by auxiliary practitioners (+6.0%) and patient transportation (+10.8%). Expenditure on curative and rehabilitative care provided by nurses and physiotherapists increases in 2023, due to a rise in the volume of healthcare consumed. Patient transportation expenditure increases again at a very high rate (+8.2%).

Expenditure on ambulatory medicines increases for the third year running, reaching €33 billion. This trend follows six years of consecutive declines in medicines expenditure, between 2014 and 2020. This increase reflects the impact of innovation and the distortion of the breakdown of expenditure by type of medicines, in favour of newer, more expensive specialties. On the other hand, the number of boxes of reimbursable medicines provided by pharmacies falls by 1.1% in 2023, mainly due to a drop in sales of painkillers. Medicine prices continue to fall in 2023 (-4.4%).

Expenditure on categories covered by the 100 % santé reform (optics, hearing aids, dental care including dentures) increases sharply in 2023 (+5.9%). This is driven by the consumption of dentures, back on the rise (+4.0%), and hearing aids (+3.0%), as well as a marked acceleration in the consumption of optics (+8.0%). The consumption of devices in baskets with no out-of-pocket expenditure rises sharply for optics (+14.2%), moderately for dentures (+3.6%), and falls for hearing aids (-4.0%). The consumption of devices in baskets with out-of-pocket expenditure increases (+6.5% overall), in similar proportions for the three types of goods. Excluding categories in the 100 % santé reform, expenditure on medical devices is slowing down, due to the fall in the consumption of sanitary masks.

The proportion of consumption of healthcare and medical goods paid directly out of the pocket of households, after financing by the French Health Insurance and supplementary health insurance, reaches 7.5% in 2023. This represents an average out-of-pocket expenditure of €274 per capita over the year. With the increase in the proportion of hospital care, financed to a greater extent by the general government, and the entry into force of the 100 % santé reform, this out-of-pocket expenditure has fallen since 2019 (8.4% of the CHMG that year). Since 2019, the financing structure of the CHMG has thus been distorted: the Social Security and the State finance 80.1% of the CHMG in 2023, that is 1.5 points more than in 2019, while supplementary health insurance finances 12.4%, that is 0.7 points less than in 2019.

Health expenditure in 2023 – Results of the health accounts – Edition 2024

Every year, results of the health accounts are presented to the Health Accounts Committee, in the presence of the Minister for Health, representatives of health professionals, leading figures from the health sectors and researchers and specialists in health economics. Compiled by DREES, health accounts are one of the satellites of national accounts produced by INSEE, whose methodology they adopt. They are also used as a basis to compile health accounts presented within international bodies (the System of Health Accounts, coordinated by the OECD, Eurostat, and the WHO) and thus allow for international comparisons of health expenditure, made on reliable and harmonised bases.

Series presented in this edition of the health accounts have been revised compared with those published in previous editions. Estimates of healthcare expenditure by medical practitioners, auxiliary practitioners and midwives as well as the consumption of ambulatory medicines have been revised downwards. Dental care expenditure has been revised upwards. The CHMG coverage rate by supplementary health insurance has been revised downwards, while the OOP expenditure rate of CHMG has been revised upwards. These revisions are the result of major methodological work carried out to enhance the accounts. Indeed, to increase the exhaustiveness of this publication, the health accounts now directly mobilise detailed data from the National Health Data System on the scope of ambulatory healthcare and medical goods and private clinics. The health accounts series have been re-estimated on the basis of this new source for the years 2021 to 2023. To ensure the consistency of the series over time, data from 2010 to 2020 have been statistically back-calculated using data from previous editions, and therefore are also revised. The revisions introduced do not lead to significant changes in the main messages provided by the health accounts (for more information, consult the website).

Lastly, the publication of the panorama is accompanied by the dissemination of datasets in CSV format, which make it possible to explore at a detailed level the consumption of healthcare and medical goods in value by category and by financer, as well as the volume-price breakdown of consumption by category.