Réduire les barrières financières à l’accès aux soins

In France, the horizontal equity principle is a founding principle of the social security. It is stated by the maxim ?From each according to his ability to pay, to each according to his need?. However, the French health insurance system lets copay-ments for all health expense, in order to contain health expenditures and give incentives to patients. However, such copayments are financial barriers to health care access and sources of inequalities in use of health services. In order to improve equity in the financial access to health services, policies have been implemented in the last decades. This paper proposes an overview of the findings of these policies and provides new results on inequalities in access to health care in France. Most policies packages consis, in setting free access to certain types of care or to reduce health insurance premiums. Free care and free insurance have been demonstrated to be effective in reducing health care use inequalities, although such actions can diminish perceived quality of the service and lead to discrimination when physician fees are caped. By contrast, the literature has also shown the ineffectiveness of health insurance premium subsidy. More recent reforms of the health system, not assessed yet, are aiming at containing prices types of care which are poorly covered by the public health insurance. Despite those policies, we demonstrate that, controlling for need, inequalities in health care use subsist, particularly on specialist, dental, optical and preventive care. This suggests that the reduction in the financial barriers to health care access is a necessary condition but far from being sufficient for achieving equity in health.