ameli.fr - Over the years

Firstly in store for salaried people and their families, health insurance general scheme has progressively concerned other categories of people, on top of the first category (young people who have already done their military service or do not have to do it, divorced women who do not work, ex-prisoners, and so on.).
Thus, health insurance gives anybody the possibility to receive healthcare according his/her needs, whatever his/her age and income levels. Today, health insurance guarantees healthcare access for nearly 55 million people.

From 1945 to nowadays

The orders of 4 and 19 October 1945 promulgated by General de Gaulle's government created a Social Security organisation. These orders combined all the previous insurances and broke away from the old form of social recognition dating back to before the war. They provided for the principle of a "management of Social Security institutions by the parties it concerns".

With extended life expectancy, development of medical progress and improvement of pensions, Social Security soon found itself in financial difficulties. To overcome these difficulties, a 1967's order created a separation into three independent branches: health, family and old-age. Each branch was thus in charge of its own resources and expenses.

The 1996's reform laid down a new chain of responsibilities between actors in the social protection system: government, parliament, managers of the Social security systems, healthcare professionals and policyholders.

The reform Parliament adopted in August 2004 aims at safeguarding the health insurance scheme, and, at the same time, at protecting and strengthening its fundamental principles: equality for healthcare access, healthcare quality and solidarity.

2005: The French Social Security system is 60 on 4 October.

Zoom in on

Article 1 of the Constitution of 1946

"An organisation of Social Security is established for the purpose of protecting workers and their families against all kinds of risks likely to reduce or remove their earning capacity and covering maternity expenses or costs of the family they are supporting."

Preamble to the Constitution of 1958 concerning Social Security

"The Nation shall provide individuals and their families with the necessary conditions for their development. It shall guarantee health protection, material safety, rest and leisure for everyone, particularly children, mothers and elderly workers. Every human being who, because of his/her age, physical or mental state or economic situation, finds himself/herself unable to work, shall have the right to receive appropriate means for living from the community."

Article 1 of the law of 13 August 2004 concerning Health Insurance
"The Nation shall affirm its commitment to the universal and compulsory character of health insurance, grounded in solidarity. Regardless of a person's age and state of health, every social health insurance policyholder shall benefit from protection against the risk and consequences of health, funded on the basis of his or her resources."

Some key dates

1945: Creation of Social Security

• Founding of the general Social Security scheme.
• Affirmation of the compulsory nature of protection against the risks of old-age, illnesses, maternity, occupational accidents, family responsibility for trade and industry employees.
• Funding through collections from wages.
• Principle of expanding the scope of Social Security to include other population groups.
• Principle of social democracy: management by the parties it concerns, i.e. joint management of funds by social partners within an administrative council.

1967: Creation of three Social Security funds and of a Central Agency

• French National Health Insurance Fund for Salaried Employees (Caisse nationale de l'assurance maladie des travailleurs salariés / CNAMTS).
• French National Old-Age Insurance Fund for Salaried Employees (Caisse nationale d'assurance vieillesse des travailleurs salariés / CNAVTS).
• French National Fund for Family Allowances (Caisse nationale des allocations familiales / CNAF).
• Central Agency of Social Security Organisations (Agence centrale des organismes de sécurité sociale / ACOSS) ensuring joint-management of the scheme's resources.

1996: Social Security reform plan

• Aim of creating a "universal health insurance scheme" enabling the automatic right to Social Security for 18-year old and over people who regularly live in France.
• Changes in the management of the Funds (particularly, return to the concept of "paritarism" within administrative councils).
• Control of healthcare expenditure.
• Reform of public and private hospital care.
• Creation of the Contribution au remboursement de la dette sociale (CRDS) applicable to work incomes, replacement incomes, assets incomes, investment incomes and other incomes, such as lottery-style games, horse bets and casinos.

2000

• Creation of the Couverture maladie universelle (CMU), a Universal Health Insurance Coverage.
• Distribution of the personal health ID card (Carte Vitale in France) for 16 year-old and over people.

2004: Health Insurance Reform
The particularly worrying financial situation of the Health Insurance system led the Government to suggest a structural reform of the system.
The law of 13 August 2004 related to health insurance redefines the organisation of available healthcare, is focused on the medicalised control of healthcare expenditure, and finally makes changes as far as the CNAMTS' managerial bodies are concerned.

2005: The French Social Security system is 60 on 4 October.