Europeanized, Marketized but Still Governed by the State? Private Health Insurance in France.

Summary Historically, private health insurance (PHI) in France (which covers the complementary share of health expenditures) has been dominated by non-profit entities, namely mutual benefit societies. The sector has experienced a manifold marketization process over the recent years, partly due to the application of EU law and regulation. Yet this chapter argues that it has been decisively reinforced and sometimes shaped by a series of policies adopted at the national level. Indeed, over the last 20 years, successive French governments have tried to increase health coverage without increasing the share already covered by the public purse. This strategy ostensibly involved private health insurers in achieving several governmental objectives, yet the prior effects of Europeanization on these entities were poorly acknowledged by policymakers. As such, the many consequences associated with the rise of a “European-driven” market now increasingly conflict with a “State-driven” market. This, in turn, has strong implications for the scope and the nature of health coverage.