The Caisse nationale d'assurance maladie des travailleurs salaries (CNAMTS) is the national health fund that is based on the belief that "There should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk" (Rodwin 2003)
The CNAMTS is financed by payroll taxes, general social contribution, and other various tax structures. All French residents are covered under an insurance fund of which they cannot opt out of. Additionally, as much as 90% of the French population is under supplementary health insurance to covered services the NHI does not cover. .
There are a variety of funds that are available of which the resident can choose from, taking into consideration of various factors such as their health, income, place of residence and family. These plans all operate within a common framework under government control. The system covers a large variety of services including outpatient services, hospital care, prescription drugs, nursing home care, cash benefits, spa remedies, dental, and vision care. Residents that are mostly older and higher-risk citizens are also supported under the CNAMTS. Those who are retired or unemployed are automatically covered by the funds that correspond to their occupation so they can receive proper care under the NHI.
There are many different reimbursement methods within the NHI. For ambulatory care, all health insurance plans reimburse only for services performed. For inpatient hospital services there are financial distributions along with by day reimbursements. The French model allows direct payment from patients to the physicians, with later reimbursement within 10 days. .
In the French system, health professionals are divided by 56% working in private practices and 36% working in public practices. Both private and public working health professionals are reimbursed based on rates determined by the government.
