The rate of generics substitution in France in June 2011 was 71%, according to a report from the Caisse Nationale de l’Assurance Maladie (CNAM), which oversees healthcare policy. This compares with Germany, where generics substitution is 96%. The goal of the French Government is to reach 85% generics substitution by the end of 2012.

In order to do this the government has introduced rules which mean that patients can no longer refuse the generics offered by pharmacists unless they are willing to pay for the alternative, although this is an advance payment that the CNAM will later refund. Pharmacists who sell too many brand-name drugs, and thus not enough generics, can also face sanctions.

The French, however, are not convinced. An Ifop opinion poll found that the number of people in favour of generics dropped five points to 57% during 2012. Forty-six per cent of the 1,009 people surveyed said that they felt the increased generics push was a violation of their freedom.

Even the smallest demands are met with resistance by some patients, with measures that charge patients 50 cents for every medicine they buy and one euro for seeing a doctor being ill-accepted by French patients. These demands are bemoaned by patients despite the fact that the French medical insurance still foots the bill for spa stays and taxi to hospitals, although transport costs will be cut in 2014 when the health authorities negotiate a new discount.

The cost of medicines reimbursed by the state (excluding hospital drugs), was stable for the first time in 2011, CNAM reported on 6 December 2012. Public spending on health services and products grew only 1.9% between 2000 and 2010, compared with 3.8% across the EU, according to the Organisation for Economic Co-operation and Development. The French healthcare system’s shortfall in 2013 is projected to be about Euros 5.1 billion, which, although it sounds bad it is a big improvement on 2010, when the shortfall was Euros 11.6 billion.

France has also imposed cuts on generics and brand-name medicines. According to Health Minister Marisol Touraine, cuts on prescription medicines will help France save another Euros 530 million during 2013.

The French consider health care as a fundamental right and are resistant to changes in the system, but the problem is that France’s healthcare costs under the current recession are unsustainable and the French will have to be more realistic about what is affordable.

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