The health status of the French population, as reflected in health and mortality indicators, ranks among the best in the industrialised countries. French life expectancy increases more than three months each year, and female life expectancy at birth (83.5 years) was second in the world after Japan in 2006. Male life expectancy, at 76.1, is unsatisfactorily low, largely because of excess road accidents and suicide. Infant mortality is just above the very low levels in Scandinavian countries.

As in other developed countries, the principal causes of death are the major noncommunicable diseases such as cardiovascular disease (31.1 percent of deaths) and cancer (27.7 percent). Other top causes are accidents (8.3 percent) and diseases of the respiratory system (8.1 percent). In 2005 France reported an adult human immunodeficiency virus (HIV) prevalence rate of 0.4 percent and 130,000 people living with HIV. From the beginning of the epidemic through June 2005, authorities reported 60,212 acquired immune deficiency syndrome (AIDS) cases and 34,351 AIDS deaths.

The general health of the French population reflects in part the success of the French health system. In 2000 the World Health Organisation (WHO) issued a first ever comparative analysis of 191 of the world’s health systems. The WHO ranked the French health care system as the “best health system in the world” (while the U.S. system was ranked 37). The WHO’s assessment was based on five performance indicators: overall level of population health; social disparities in care; health system responsiveness (measured partly by patient satisfaction); distribution of service within the population; and distribution of the health system’s financial burden, including out-of-pocket expenses.

France’s total expenditure on health as a percentage of gross domestic product (GDP) is 10.1, among the highest rates in the Organisation for Economic Co-operation and Development (OECD) but significantly lower than the U.S. rate of 16 percent. French spending is higher than other universal systems, such as that of the United Kingdom, which spends an unusually low 6 percent of GDP. France’s per capita expenditure is about US$2,902 (2003).

The French system is a national health insurance (NHI) system, with a public-private mix of hospital and ambulatory care. It provides universal coverage and comprehensive benefits, with the right to health insurance coverage on the basis of residence in France. Providers such as doctors and dentists are free to establish private practices. Patients are free to choose their own providers, usually require no referrals to see specialists, and generally encounter no significant waiting lists for treatment. Health spending is reimbursed generously by the state. At the same time, private insurers are not excluded from the supplementary insurance market. Low-income people receive extra help with their health spending. Given the strengths of the system (quality of care, freedom of choice and equity of access), the French population is relatively satisfied with the health system. However, the recognised strengths come at the price of high and rising costs. Reform efforts to rein in costs, which have shifted costs to the patient through higher out-of-pocket payments, have proven ineffective and raise equity questions.