| Course | HS820 Global and National Health and Health Systems |
|---|---|
| Unit | Unit 4 |
| Paper type | Financing analysis |
| Length | About 1,200 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Health Science (DHSc) |
| Updated | October 2026 |
Free sample paper for HS820 Unit 4
Following One Euro to a French Doctor's Visit: A Unit 4 Financing Analysis Through Collection, Pooling and Purchasing
[Student Name]
Purdue University Global
HS820: Global and National Health and Health Systems
Unit 4 Financing Analysis
[Instructor Name]
[Date]
The facts about France and the sources cited are real; figures are rounded for the course.
Framework
Health financing can be analyzed through three functions: collection, how money is raised and from whom; pooling, how it is gathered and risk is shared; and purchasing, how it is used to pay providers (Kutzin, 2001). France is a useful case because its financing has changed substantially since the 1990s, moving from a classic payroll-funded social insurance model toward a mix of payroll, earmarked taxes and complementary private insurance (Chevreul et al., 2015). Each section below answers who pays, who decides and what passes to the next stage.
Collection: Who Pays
Three main sources fund statutory health insurance. Employers pay a payroll contribution on wages, the largest single source. The generalized social contribution, known as the CSG, is a levy on a broad base of income, including wages, pensions, investment income and some social benefits; since 2018, an increase in the CSG has replaced the employee's share of the health insurance contribution, so employees no longer pay a separate health premium from their wages. Earmarked taxes, including taxes on tobacco and alcohol and a share of value-added tax, provide the remainder.
Who decides: Parliament sets the contribution rates and the CSG through the annual social security financing law.
Incidence: the shift from employee payroll contributions to the CSG spread the burden from wages alone to a broader base that includes retirees and investment income. This matters for fairness: a tax on all income is generally less tied to employment than a payroll charge and reaches people with income from assets.
What passes on: a single national stream of revenue flows to the national health insurance system.
Pooling: Who Shares the Risk
Statutory health insurance is organized through a small number of schemes, the largest covering employees and, since 2016, nearly all residents under a universal health protection law that made coverage depend on residence rather than employment. Money from all collection sources is pooled nationally. A resident's entitlement does not depend on how much he or she contributed.
Who decides: the national health insurance fund manages the pool under targets set by Parliament, including a national ceiling on health insurance spending growth.
What passes on: a national budget for health insurance spending, divided among hospitals, ambulatory care and other sectors.
Purchasing: Who Pays the Doctor
When a patient visits a general practitioner, statutory insurance reimburses a set share of the official fee, typically about 70 percent for a doctor registered with the system, minus a small fixed deductible per visit. The remaining share, the ticket moderateur, is usually paid by a complementary insurer, which most residents hold through employers, mutual societies or private insurers. Since 2016, employers have been required to offer complementary coverage to employees, and a public complementary scheme covers people with low incomes.
Who decides: fees are set in national agreements between the health insurance fund and doctors' unions. Doctors in sector 2 may charge above the official fee, and those excess charges may be partly covered by complementary insurance.
What reaches the doctor: for a typical visit, a payment from statutory insurance and a payment from the complementary insurer, often handled electronically so that the patient pays little or nothing at the point of care.
The French doctor is paid from two pools that answer to different rules, and the patient feels the system as one only because the two settle the bill between them.
The Flow in One Picture
A flow diagram on page two traces the euro: from employer, CSG and earmarked taxes into the national pool; from the pool to the doctor as about 70 percent of the official fee; from the patient's complementary insurer for most of the rest; and from the patient for any deductible or excess fee.
What the Flow Produces
France achieves very low out-of-pocket spending compared with many high-income countries, because complementary insurance covers most of what statutory insurance leaves. But the two-layer design has costs. Complementary insurance adds administrative expense, and people without it, a small minority, face higher costs. Excess billing in sector 2 can create access problems in some specialties and regions. Comparative profiles describe France as having broad coverage with a significant role for voluntary insurance (Tikkanen et al., 2020).
Is France a Bismarck System?
France is often labeled Bismarckian because of its historical roots in employment-based social insurance. Its current financing, with residence-based entitlement, a broad income levy and earmarked taxes, has moved toward a hybrid. The functional analysis shows the label explains less than the flows do.
Equity Across the Three Functions
Each function has its own equity question. In collection, the move to the CSG made financing more progressive by taxing income beyond wages. In pooling, residence-based entitlement removed gaps for people outside formal employment. In purchasing, excess billing and the reliance on complementary insurance can disadvantage people with lower incomes or without employer coverage, even though a public complementary scheme exists for the poorest. A full equity assessment would weigh these together rather than judge the system on any one function.
A Worked Example: One Visit in Numbers
Take a consultation with a sector 1 general practitioner whose official fee is 30 euros. Statutory insurance reimburses 70 percent of that fee, which is 21 euros, and then withholds the fixed deductible of 2 euros per visit, so the national pool pays 19 euros. The complementary insurer pays the remaining 30 percent, 9 euros. The patient is left with the 2-euro deductible, which complementary contracts are not allowed to reimburse under the rules for so-called responsible contracts. If the same visit is with a sector 2 specialist who charges 50 euros against an official fee of 30 euros, the pool still pays on the official fee only, and the 20-euro excess falls to the complementary insurer, if the contract covers it, or to the patient. The worked figures show how one design choice, the official fee, decides how much of each visit sits in the public pool and how much is left to private arrangements.
What a U.S. Reader Should Notice
Three features of the French flow differ sharply from U.S. arrangements. First, entitlement follows residence, not a job, so losing employment does not interrupt statutory coverage. Second, the official fee is negotiated once nationally, which removes the price bargaining between many insurers and many providers that drives administrative cost in the United States. Third, complementary insurance in France fills a defined gap inside a public price schedule, whereas supplemental coverage in the United States often sits on top of prices that vary by payer. These contrasts explain why France can keep out-of-pocket spending low while still relying on private insurers for part of every visit.
Limits
The analysis follows a single type of visit. Hospital financing, long-term care and medicines follow different paths, and a fuller analysis would trace each. Figures change with annual financing laws.
References
Chevreul, K., Berg Brigham, K., Durand-Zaleski, I., & Hernandez-Quevedo, C. (2015). France: Health system review (Health Systems in Transition, Vol. 17, No. 3). European Observatory on Health Systems and Policies.
Kutzin, J. (2001). A descriptive framework for country-level analysis of health care financing arrangements. Health Policy, 56(3), 171-204. https://doi.org/10.1016/S0168-8510(00)00149-4
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020). International health care system profiles. The Commonwealth Fund.
Reading the HS 820 Unit 4 instructions
The fourth unit usually asks for an analysis of how one country finances health care, organized by a recognized framework. Expect a paper of several pages with a flow diagram. Kutzin's three functions, collection, pooling and purchasing, are the standard choice. Follow money through each stage and ask the same questions at every step: who pays, who decides and what moves to the next stage. Pick one service, such as a primary care visit, so the flow can be traced end to end. Report contribution rates and shares with dates and sources. A worked example with round figures makes the analysis checkable. Consider equity at each function, and test any label you use against the flows you have traced.
Inside the HS820 Unit 4 example
The sample opens with the framework and a citation to Kutzin, then the French system review. Collection covers employer payroll contributions, the CSG levy that replaced the employee's share in 2018 and earmarked taxes, with a note on incidence. Pooling covers residence-based entitlement since 2016 and the national spending ceiling. Purchasing explains the 70 percent reimbursement, the ticket moderateur paid by complementary insurers and sector 2 excess billing. The highlighted sentence observes that the doctor is paid from two pools that settle the bill between them. Later sections describe the flow diagram, what the flow produces, whether France is Bismarckian, equity across functions, a worked 30-euro visit, contrasts a U.S. reader should notice and limits.
Reading the HS820 Unit 4 grading rubric
Financing analyses in HS820 are typically marked on use of a framework, accuracy, depth of analysis, the diagram, sources and writing. The framework and analysis rows usually carry the most points: graders want every stage answered in the same terms and conclusions about what the flow produces. Accuracy covers rates, shares and dates from authoritative sources. The diagram should match the text and be readable. Analyses that describe a health system in general, or that skip a function, lose marks. Attention to equity and to who decides at each stage is often rewarded. A worked numerical example tends to earn credit for clarity. The system review and the framework each need a full reference entry. Tracing who decides at each stage, Parliament, the national fund or the fee negotiators, often separates a strong paper from an adequate one.
Common HS820 Unit 4 mistakes, and how to avoid them
Learners often describe a country's insurance arrangements without tracing the money, which leaves the framework unused. Others mix up pooling with purchasing, or forget who sets the rates. Figures without years are another weakness. Diagrams sometimes show boxes without amounts or directions. If you have a different country, perhaps Germany, Japan or Australia, send the prompt, and we can trace one service through all three functions with current figures and a matching diagram for that system. A common slip is treating the CSG as a payroll charge, when its point is that it taxes pensions and investment income as well. Another is forgetting the deductible that complementary contracts may not repay, which changes what the patient actually pays.
Get an HS820 Unit 4 example written to your instructions
Financing analyses differ mainly in the country and the framework, so share both, where your Unit 4 instructions specify them, along with the rubric. The analysis will trace each stage from revenue to the consultation, examine who bears each levy, and include a diagram that matches the text. Ready in 24-48h; a first custom sample is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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HS820 Unit 4 questions, answered
What framework does a financing analysis usually use?
Collection, pooling and purchasing, the three financing functions set out in the WHO's work on health systems, are the most common. They force the analysis to show where money comes from, how risk is shared and how providers are paid. Some sections add a fourth stage, the point of care, which the sample includes because out-of-pocket spending is where equity shows.
Is France a Bismarck system?
It began as one, built on payroll contributions managed by social insurance funds, and much of that structure remains. But the CSG, residence-based entitlement and a parliamentary spending target have moved it toward tax financing and state control. The sample describes it as a hybrid and explains which features pull in each direction, rather than forcing a single label onto it.
How detailed should the diagram be?
Detailed enough to show every stage the text discusses and no more. The sample's diagram runs from revenue sources through the national fund and complementary insurers to providers and patients, with arrows labeled by type of payment. A diagram crowded with minor funds becomes unreadable, and one that omits complementary insurance misrepresents the French system.
Where can I find a free HS820 Unit 4 sample paper?
This page shows the complete Unit 4 analysis, tracing one euro to a French doctor's visit through collection, pooling and purchasing.
Why trace one visit rather than the whole system?
Because a single service can be followed end to end with real figures, which makes each stage checkable; hospitals and medicines follow other paths.