Solicitud directa (CEACR) - Adopción: 2004, Publicación: 93ª reunión CIT (2005)

The Committee notes, from the seventeenth annual report submitted by the Government of France to the Council of Europe on the application of the European Code of Social Security, the important modifications in French social security legislation which affect in particular Parts II, V and VII of the Convention. So as to be able to assess their impact on the application of the various provisions of the Convention, the Committee would be grateful to be provided with additional information on the following points:

Part II (Medical care) of the Convention. According to the report, the substantial and rising deficit of the health branch, at over €10 billion in 2003, led the Government to announce its intention in October 2003 to undertake an in-depth adaptation of health insurance to guarantee the durability of the current system, which is based on solidarity, universality, free choice of practitioner and quality for all. A diagnosis of the causes of the current situation was undertaken in January by the High Council for the Future of Health Insurance, composed of parliamentarians, social partners, representatives of the State and of institutions, health care professionals, users and experts. On this basis, and following a period of dialogue, a Bill has recently been submitted to Parliament. It includes measures intended to secure both better medical control and better governance of the health system, while at the same time increasing the income of the health insurance system. These measures should enter into force in 2005 and the objective of the Bill is to achieve financial equilibrium in 2007. In the meantime, the Act of 2004 respecting the financing of social security has established a series of emergency measures designed to increase resources so as to stabilize the health insurance deficit in 2004. These include: an increase in the tax on tobacco and the contribution based on the promotional expenditure of pharmaceutical laboratories; the establishment of an extraordinary contribution by the pharmaceutical industry based on the turnover achieved in France in 2004; and a specific contribution based on the commercial expenditure of producers and distributors of medical equipment.

The Committee notes the scope and urgency of the problems encountered by the Government and the national mobilization to safeguard the system of health insurance based on the principles of solidarity, universality and quality health care for all, which are also the principles underlying Part II of the Convention. It recalls that, irrespective of the situation, the Government has to accept general responsibility for the due provision of the benefits provided in compliance with the Convention and to take all measures required for this purpose (Article 71(3) of the Convention). To maintain the financial equilibrium, it is under the obligation, among other measures, to ensure that the necessary actuarial studies and calculations are made periodically and therefore any necessary changes in contribution rates or the taxes allocated to covering the contingencies in question or, finally, the volume of benefits themselves. Although the measures set out in Article 71(3) are essentially intended to prevent situations of crisis through the judicious and forward-looking governance of the system, compliance with this provision becomes particularly important for the management of emergency measures. The same applies to the general responsibility that the Government has to assume for the proper administration of social security institutions and services (Article 72(2) of the Convention), which is rendered still more difficult under the conditions of a substantial and rising deficit for the health branch. The Committee notes from the Government’s report that it is assuming the general responsibilities envisaged by the Convention with regard to the provision of benefits and the administration of the health branch and that it is taking measures to improve the situation in the short term. However, it requests the Government to continue providing detailed information and data showing the effectiveness of these measures in relation to its objective of returning the branch to equilibrium by 2007. It would also like to be informed of the measures adopted or envisaged to safeguard the long-term future of the system.

In this context, the Committee draws the Government’s attention to the fact that, in accordance with Article 71(1) of the Convention, the implementation of measures, both emergency and long-term, has to be such that hardship is avoided for persons of small means and the economic situation of the classes of persons protected is taken into account. With regard to the volume of benefits provided by the branch, the Government, while seeking better financial and medical control of health insurance, has to ensure that the benefits provided are not merely confined to care in respect of medical conditions, but are also intended to maintain and improve the health of the persons protected (Articles 7 and 10(3) of the Convention), having recourse, in so far as possible, to general public health services (Article 10(4)). The Committee wishes to recall in this respect Recommendation 1626 (2003) of the Parliamentary Assembly of the Council of Europe concerning the reform of health care systems in Europe, which specifies that "the main criterion for judging the success of health system reforms should be effective access to health care for all without discrimination, which is a basic human right. This also has the consequence of improving the general standard of health and welfare of the entire population". Bearing these considerations in mind, the Committee requests the Government to provide the text of the above legislation, when it has been adopted, accompanied by detailed explanations of the impact that it could have on the application of each of the Articles of Part IIof the Convention.

The Government also indicates in its report that Act No. 2003-1199, of 18 December 2003, respecting the financing of social security, embarked upon a major reform of the method of financing of public and private hospitals by organizing the progressive transition between 2004 and 2012 towards the itemization of charges based on the care provided. It strengthens the role of regional institutions in the policy of containing expenditure on out-patient care. Finally, it modifies the procedure for access to exemptions from cost-sharing by patients suffering from "long-term conditions". Reimbursement of care and benefits at the rate of 100 per cent will be limited to those determined in a diagnosis and care protocol drawn up jointly by the patient’s personal doctor and the advisory doctor of the health insurance fund. While recognizing the need for the policy to contain expenditure on out-patient care, the Committee recalls that specialist care provided at hospitals for out-patients constitutes not only an essential element of the benefits envisaged in Part II of the Convention, but also the type of care which offers the best cost/effectiveness ratio, as shown by the common experience of developed countries. With regard to the transition to itemized charges for hospital care, and the new procedure for exemption from cost-sharing in the case of long-term illness, the Committee draws attention to the fact that, under Article 10(2) of the Convention, the rules relating to the sharing by beneficiaries or their breadwinners in the cost of medical care have to be designed so as to avoid hardship. The Committee would like the Government’s next report to contain fuller information on this subject.

Part V (Old-age benefit). The Committee notes the adoption of Act No. 2003-775, of 21 August 2003, reforming pensions, which is intended to safeguard the pay-as-you-go pensions system by ensuring its financial equilibrium up to 2020. According to the Government’s report, the reform is based on three main areas: (1) securing a high level of retirement benefits by prolonging working life and the period of insurance; (2) preserving the equity and spirit of social justice of retirement schemes; and (3) enabling each individual to build up her or his retirement provision by allowing greater flexibility and freedom of choice. Several measures have been adopted to achieve national mobilization to promote work by employees over 55 years of age. The age at which workers are automatically placed in retirement by employers without this constituting dismissal is being progressively raised to 65 years by 2008. Progressive retirement is being improved by ensuring that continued part-time work gives rise to additional pension entitlements and the rules relating to the combination of paid work and definitive retirement benefits are being made more flexible and harmonized.

With regard to the parameters of the retirement system as set out in the Convention, such as the qualifying period and the minimum rate of the replacement income, the Committee notes in particular that the reform is intended to secure a high level of retirement benefits, averaging two-thirds of income from employment by 2020, by prolonging the period of insurance and of work. The common minimum age set out in law for retirement remains 60 years. However, the reference period for the calculation of the retirement pension in the general scheme is being raised from 150 to 160 quarters by 2008. The minimum period of contributions to obtain a full-rate retirement benefit will therefore rise to 40 years. The convergence upon 40 years of contributions in 2008 for private sector employees, public officials and the self-employed will then develop so as to maintain the ratio to the average length of retirement constant up to 2020 in view of rising life expectancy. To do so, the Act envisages the extension of the contribution period by one quarter every year between 2009 and 2012. The length of contributions necessary to obtain a full-rate retirement benefit will accordingly reach 41 years in 2012, unless this period is modified on the basis of a public report by the Government forwarded to Parliament before 1 January 2008, and may then reach 41 and three-quarter years in 2020. Periods of work covered by contributions may be supplemented by the validation of periods of the interruption or reduction of work on grounds of family responsibilities up to a ceiling of three years for children born or adopted after 1 January 2004. Workers bringing up a severely disabled child may benefit from the granting of a supplementary period of insurance up to a ceiling of two years. Workers may buy back periods spent studying, up to a maximum of three years. Contribution options based on full-time equivalents are available for part-time workers.

With regard to the calculation of the old-age benefit, a pension supplement, known as a surcote, is established for periods of contribution beyond the age of 60 years and the completion of 160 quarters of contribution. Pension reductions, known as décotes, will be progressively reduced from 10 to 5 per cent for each missing year from the contribution period between 2004 and 2013 (between 2006 and 2020 for the public sector). Persons who have a full career at the minimum wage will be guaranteed a retirement objective in 2008 (basic and compulsory supplementary pay-as-you-go) of 85 per cent of the net minimum wage (SMIC). Minimum contributory pensions will be supplemented by up to 8 per cent based on the periods for which contributions have actually been paid by the worker. The reform ensures that the various categories of retirees benefit from the same indexation of their pensions and non-contributory benefits, which will henceforth be aligned with prices.

In view of the extension of the insurance period and the reduction of pension benefits for missing years, the Committee draws attention to the fact that an old-age benefit of the minimum level required by the Convention (40 per cent of the reference wage) must be secured in all cases for a standard beneficiary (with a spouse of pensionable age) who has completed the qualifying period set out in Article 29, paragraph 1(a), of the Convention (30 years of contribution or employment) and a reduced benefit must be secured at least after a qualifying period of 15 years, under paragraph 2(a) of the same Article. The Committee would be grateful if the Government would provide detailed information in its next report on the impact of Act No. 2003-775 on the application of each of the Articles of Part V of the Convention, including statistical information, as requested in the report form under Article 76, paragraph 1(b)(i) and (ii) (in relation with Article 65 or 66) as they relate to old-age benefit. With regard more particularly to the qualifying period, please indicate any periods of interruption of the contribution period or of reduced working time which may be validated with a view to supplementing the insurance period. With regard to the calculation of benefits, please indicate the amount of retirement pension which will be received in 2008 by a standard beneficiary who has completed 30 years of contributions and employment at the minimum wage. The Committee would also be grateful if the Government would indicate the extent to which it envisages taking into account, for the purposes of the application of Part V of the Convention, in addition to the general old-age insurance scheme, the benefits provided by the various compulsory supplementary and additional retirement schemes (such as ARRCO, AGIRC, the additional compulsory retirement scheme for public officials established on 1 January 2005), and by the voluntary retirement insurance and savings schemes (PPESV, PERCO, PERP) referred to in the report. Finally, the Committee reserves the possibility of examining the whole of the new legislation in detail when it has received the information requested, accompanied by the relevant legislative texts.

Part VII (Family benefit). With a view to significantly improving the reconciliation of family and working life, while at the same time simplifying benefits by making them easier to understand, the Act respecting the financing of social security for 2004 established a new family benefit intended to facilitate the arrival, maintenance and bringing up of young children as from the first child: the benefits related to birth and adoption (young child allowances (APJE) and adoption allowances (AA) and assistance for the care of young children (parental allowance for bringing up children (APE), assistance to the family for the employment of an approved maternal assistant (AFEAMA) and the allowance for child care at home (AGED)) are replaced by the benefit for the care of young children (PAJE).

The PAJE is intended to reconcile in the same benefit the objectives of family policy and those of economic and employment growth with a view to increasing both the birth rate and the participation rate in the medium term. It includes, as a first stage, a birth subsidy paid at the seventh month of pregnancy or an adoption subsidy (€812.37), followed by a basic allowance provided from birth for three years (€162.47 a month). The means-related condition is relaxed and should raise the number of beneficiary families from 80 to 90 per cent.

The PAJE includes a second phase relating to choices concerning the care and upbringing of children. The supplement for free choice of employment is granted to a parent who chooses not to be engaged in her or his occupational activity, or to exercise it on a part-time basis to care for a child for a period which varies according to the rank of the child (a maximum of six months for a child of the first rank and three years for a child of the second or higher rank). This supplement is granted without conditions as to means, but as a function of a period of previous activity, which also differs according to the rank of the child (€504.11 a month in the absence of occupational activity, €383.33 for work of up to 50 per cent and €289.87 for work between 50 and 80 per cent). Parents wishing to continue working receive a supplement for free choice of the manner of providing care, including the coverage of all or part of the social contributions relating to the employment of a maternal assistant or a carer at home, and part of the wages of these persons up to a ceiling that varies according to the family income. The supplement is paid up to the age of 6 years, although its amount is reduced by 50 per cent between 3 and 6 years of age (between €152.54 and €355.96 a month for a child between 0 and 3 years).

In view of the above changes, the Committee requests the Government to provide up-to-date statistical information, as required by the report form under Article 44 of the Convention, with regard to the total amount of family benefit.