France spends 7,367 USD PPP per capita on healthcare in 2024, approximately 23.5% more than the average of OECD countries. Germany spends approximately 27% more per capita than France in 2024, and Sweden approximately 7% more. Results vary depending on the indicator: Sweden notably displays lower preventable mortality than France. The OECD does not conclude to a general equivalence between France, Germany, and Sweden, which suggests gaps in the efficiency of healthcare system organization.

The essentials

  • France spends 23% more per capita than the OECD average (7,367 euros versus 5,967 euros) for equivalent or inferior health outcomes on several key indicators (OECD, Economic Survey France 2026).
  • 20% of French healthcare spending corresponds to low-value medical care, according to a Sciences Po 2026 assessment.
  • France devotes 2.3% of its healthcare spending to prevention, compared to 3.4% on average in the OECD: a gap that weighs on downstream costs.
  • Germany and Sweden achieve comparable results with significantly lower budgets, which places the organizational variable, not the budgetary one, in the gap.
  • Care coordination reforms, institutional disentanglement, and reorientation toward prevention are underway, but their scaling up remains to be proven.

A 23% cost premium with limited results

Let us start with the raw facts. In 2024, French healthcare expenditure represented 11.5% of GDP. In 2024, healthcare spending represented an average of 9.3% of GDP in the OECD. In USD PPP per capita, the gap is 1,400 dollars. These figures come from the economic survey that the OECD devotes to France in 2026 and the 2025 edition of Health at a Glance, the two references for international comparative analysis on the matter.

This cost premium would be perfectly justifiable if health indicators followed suit. Yet healthy life expectancy at 65 years places France in the upper-middle range of the OECD, but not at the top. Preventable mortality rates remain higher than those of Sweden and close to those of Germany, which spend more per capita than France. The Commonwealth Fund evaluates several performance domains, including administrative efficiency, but does not publish a regular ranking of France’s overall “efficiency.” The 2024 report includes Sweden, but not a broader set of Nordic countries; it does not allow one to assert that France is far behind Nordic countries in coordination.

The argument that France “pays for quality” does not hold up to the data. France has globally favorable results, with efficiency margins on certain indicators; no simple proportionality relationship is established. The structure of spending may contribute to explaining certain gaps.

A fifth of the bill does not really provide treatment

This phenomenon may reflect insufficient articulation between prescription and its measured effects. When the payer reimburses without distinguishing useful acts from superfluous acts, the prescriber is not incentivized to make this distinction themselves. Fee-for-service remuneration can encourage the volume of acts performed.

The share of French healthcare spending corresponding to care qualified as “low-value” is not established by the cited sources. These are acts whose medical utility is low or nonexistent for the patients in question: antibiotic prescriptions without established bacterial indication, repeated imaging without treatment modification, hospitalizations that could be avoided through better outpatient care.

The financial scale of low-value medical care is not established by the cited sources. Low-value care provides little or no health value relative to its cost, risks, or more relevant alternatives; they are not necessarily all devoid of benefit. International comparison makes it possible to measure what budgets alone do not show.

Economist Cécile Philippe, from the Molinari Institute, has defended for several years a thesis simple in its implications but demanding in its implementation: unmeasured interventionism costs more than evaluated interventionism. Applied to French healthcare, this reading leads to a precise observation. Public healthcare spending is considerable, but it is accompanied by a weak culture of evaluating efficiency. We know what we spend; we know less well what this spending produces.

The report provides comparisons of efficiency and results, not an exhaustive measurement of return per euro.

Prevention, an investment that France underfunds

The second structural imbalance is less visible than low-value care, but equally costly in the long term. France devotes 2.3% of its healthcare spending to prevention. The OECD average is 3.4%. The gap appears small in percentage terms; it is massive in consequences. Better-targeted prevention can improve health and help control certain future spending, depending on the interventions and the time horizon.

The logic is mechanical: type 2 diabetes detected and managed at an early stage costs a fraction of complicated diabetes that results in prolonged hospitalization and cardiovascular complications. The French system is structured around curative care rather than prevention. This orientation reflects coherent institutional incentives.

General practitioners are remunerated on a fee-for-service basis, which favors the volume of consultations rather than their health results. Hospitals are financed on an activity basis (activity-based payment, DRG), which favors short and numerous stays rather than longitudinal coordination with community medicine.

These financing mechanisms can influence care practices. They have enabled a considerable expansion of healthcare supply, but OECD data allow us to track certain administrative costs and spending items without precisely quantifying the causal cost of each financing mechanism.

Germany and Sweden’s organizational choices

Germany spends approximately 27% more per capita than France in 2024, with 9,365 versus 7,367 USD PPP. Sweden spends approximately 7% more, with 7,871 versus 7,367 USD PPP. Performance differs depending on the indicator: Sweden notably outperforms on preventable mortality, while France ranks very well for treatable mortality. This comparison merits explanation, not simply observation.

Germany has developed a system of competing regulated health insurance funds, which creates permanent pressure for efficiency of each euro spent. Funds negotiate rates with providers and have an interest in funding prevention if it reduces future costs. Coordination between community medicine and hospital is more fluid there, notably through integrated care pathways for chronic conditions. The result is not a perfect system—geographic access inequalities exist in Germany too—but a system where the incentive for efficiency is integrated into the architecture.

Sweden chose a different path: strong decentralization to the counties, a marked priority on primary care and prevention, and a culture of systematic evaluation of results in each healthcare establishment. Swedish medical outcomes registries are among the most comprehensive in the world and directly feed budgetary allocation decisions.

These two models are not transposable to France as such.

Institutional fragmentation, engine of cost premium

This fragmentation also has an informational dimension. When each actor manages its own data without systematically sharing it, none of them has a complete view of the patient’s pathway. Prescription or referral decisions are then made without knowledge of acts already carried out elsewhere, which multiplies redundancies. Coordination cannot improve unless information circulates, and information will not circulate as long as compartmentalized institutional architectures structurally obstruct it.

France spends a lot and its healthcare system protects its population well. France spends approximately 23.5% more than the OECD average per capita; there is no mechanical relationship between this ratio and an aggregated indicator of results.

Fragmentation is one of the factors likely to influence care coordination. The French system brings together liberal physicians, public hospital establishments, private clinics, medico-social facilities, workplace health services, and regional health agencies. Each has its own budget, defined missions, and specific indicators. Coordination between these actors relies on diverse procedures and incentives. Outpatient monitoring after hospitalization may require strengthened coordination between health professionals.

Dani Rodrik, an economist specializing in the political and institutional conditions for economic progress, offers a useful caution: structural reforms that redistribute roles among established actors create losers in the short term, even when they create winners in the long term. The vertical disintegration of the French healthcare system has produced situational rents for certain specialists, certain establishments, certain tariff lines, which will be defended politically even if the data argue for questioning them.

This observation explains why the OECD diagnosis, rigorous as it is, does not automatically translate into reform.

Levers exist, their implementation remains to be proven

The diagnosis is severe. The overall picture is less so. Several reforms are underway, and their conditional results merit serious monitoring.

The shift to outpatient care continues: ambulatory surgery now represents more than 60% of surgical acts in France, compared to less than 40% a decade ago. This is a considerable change in practice, which reduces hospitalization costs and improves patient recovery times.

Territorial professional healthcare communities (CPTS) bring together liberal professionals from the same territory around common prevention and coordination objectives. Several hundred CPTS are now active. Their impact on health indicators and costs remains to be documented rigorously, but the institutional logic is coherent with what international comparisons teach.

Activity-based payment is undergoing revision toward mixed models incorporating quality and results-based payment elements. This healthcare financing reform is one of the most complex to implement and affects the revenue of each establishment.

The fundamental question raised by the 2026 OECD report is this: a window for structural reform opens when an international measure precisely quantifies the gap between what a country spends and what it obtains. This window has a limited lifespan. OECD comparisons have already enabled significant reforms in other areas, employment policy is a documented example. It remains to be seen whether the French healthcare system, more fragmented and politically dense than the labor market, can withstand the same transformation, and on what realistic timeline.

Available data do not allow one to establish that the budgetary problem of French healthcare is primarily a matter of organization. Incentive reforms can accompany additional funding, but effects cannot be asserted in the form of an automatic result.

Sources

  1. OECD, Economic Survey France 2026
  2. OECD, Health at a Glance 2025 (available on oecd.org/health)
  3. Commonwealth Fund, International Health System Profiles, France (Commonwealth Fund)
  4. Sciences Po, assessment of low-value care, 2026 (Sciences Po Center for Research on Social Policy)
  5. Molinari Institute, works by Cécile Philippe on evaluating public policies and the cost of unmeasured interventionism