French medical device market will grow at an average annual rate of 4.7%, from EUR 13.5 billion (2018) to EUR 15.5 billion in 2021 (BMI Research). The French medical technology association SNITEM (Syndicat National de L’Industrie des Technologies Medicale) even expects sector sales of EUR 28 billion (2016), of which EUR 8 billion will be exported. A look at health expenditure in 2017 shows a share of 11.5% of GDP (Germany 11.3%) (OECD)
France consists of metropolitan France in Western Europe and several overseas regions and territories. The metropolitan area of France extends from the Rhine to the Atlantic Ocean and from the Mediterranean Sea to the English Channel and the North Sea. It borders Belgium, Luxembourg and Germany to the northeast, Switzerland, Monaco and Italy to the east and Andorra and Spain to the south. The overseas territories include French Guiana in South America and several islands in the Atlantic, Pacific and Indian Oceans. The country’s 18 integral regions (five of which are situated overseas) span a combined area of 643,801 km2 (248,573 sq mi) and a total population of 67.07 million (as of June 2020). France is a unitary semi-presidential republic with its capital in Paris, the country’s largest city and main cultural and commercial center.
Following the revolution, France reached its political and military zenith in the early 19th century under Napoleon Bonaparte, subjugating much of continental Europe and establishing the First French Empire. The French Revolutionary and Napoleonic Wars shaped the course of European and world history. After the collapse of the empire and a relative decline, France endured a tumultuous succession of governments culminating in the establishment of the French Third Republic in 1870 in the midst of the Franco-Prussian War. France was one of the prominent participants of World War I, from which it emerged victorious, and was one of the Allied powers in World War II, but came under occupation by the Axis in 1940. Following liberation in 1944, a Fourth Republic was established and later dissolved in the course of the Algerian War. The Fifth Republic, led by Charles de Gaulle, was formed in 1958 and remains to this day. Algeria and nearly all other French colonies became independent in the 1960s, with most retaining close economic and military connections with France.
France retains its centuries-long status as a global center of art, science, and philosophy. It hosts the world’s fifth-largest number of UNESCO World Heritage Sites and is the leading tourist destination, receiving over 89 million foreign visitors in 2018. France is a developed country with the world’s seventh-largest economy by nominal GDP, and the tenth-largest by PPP. In terms of aggregate household wealth, it ranks fourth in the world. France performs well in international rankings of education, health care, life expectancy, and human development. It remains a great power in global affairs, being one of the five permanent members of the United Nations Security Council and an official nuclear-weapon state. France is a founding and leading member of the European Union and the Eurozone, and a member of the Group of 7, North Atlantic Treaty Organization (NATO), Organization for Economic Co-operation and Development (OECD), the World Trade Organization (WTO), and La Francophonie.
Healthcare Sector
The French health care system is generally recognized as offering one of the best, services of public health care in the world. Above all, it is a system that works, provides universal cover and is a system that is strongly defended by virtually everyone in France.
The health care system in France is made up of a fully-integrated network of public hospitals, private hospitals, doctors and other medical service providers. It is a universal service providing health care for every citizen, irrespective of wealth, age or social status.
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the “best overall health care” in the world. In 2017, France spent 11.3% of GDP on health care, or $5,370 per capita, a figure higher than the average spent by rich countries (OECD average is 8.8%, 2017), though similar to Germany (10.6%) and Canada (10%), but much less than in the US (17.1%, 2018). Approximately 77% of health expenditures are covered by government funded agencies.
Most general physicians are in private practice but draw their income from the public insurance funds. These funds, unlike their German counterparts, have never gained self-management responsibility. Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded). The French government generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until 2000, coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place universal health coverage and extended the coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and dental care (35.9%) (figures from the year 2000). There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals.
Medical device market
With 67 million inhabitants, France is the second largest market in Europe after Germany. And this also applies to the Medical Device sector. Therefore, medical device manufacturers from all over the world would like to place their products here as well. But how can a successful market entry take place?
According to forecasts by BMI Research, the market will grow at an average annual rate of 4.7 percent, from EUR 13.5 billion (2018) to EUR 15.5 billion in 2021. The French medical technology association SNITEM (Syndicat National de L’Industrie des Technologies Medicale) even expects sector sales of EUR 28 billion (2016), of which EUR 8 billion will be exported. A look at health expenditure in 2017 shows a share of 11.5% of GDP (Germany 11.3%) (OECD).
Total market demand in France for medical equipment was estimated at $40.3 billion in 2019, with imports accounting for $14 billion. Imports from the United States were forecasted at USD 4.7 billion, or 33.5% of total imports. This percentage is expected to remain approximately the same over the next two years, with overall demand growing at 3% annually.
The French medical device market is the second largest market in Europe and the fifth largest in the world.
French manufacturers used to control the majority of the domestic medical device industry, but the current market relies increasingly on imports as manufacturing shifts to other parts of the world. Medical device imports amounted to $3.8 billion in 2015, more than 50% of the overall market. However, French device manufacturers are sophisticated and formidable, presenting significant competition to importers selling in France.
Opportunities in the French market: The French medical device market is robust. Manufacturers producing in-demand technologies such as diagnostic imaging equipment, disposable medical products, non-invasive surgical devices, orthopedic implants, intensive care equipment, hygiene products, and other innovative products will find their products are well-received.
Industry challenges in France: It is difficult to predict how the French medical device market will evolve in the next few years. The relatively weak Euro continues to benefit French companies exporting to the US, but presents ongoing challenges for importers, particularly from the United States. Nonetheless, foreign manufacturers continue to recognize the size and potential of the French market but face hefty competition from large, multinational corporations with established subsidiaries in France.
How France compares to other markets
| FRANCE | GERMANY | UNITED KINGDOM | |
| Population | 66,553,766 | 80,854,408 | 64,088,222 |
| Primary language(s) | French | German | English |
| Total healthcare spending | $330 billion | $437 billion | $252 billion |
| Healthcare expenditures total (% of GDP) | 11.5% | 11.3% | 9.1% |
| Healthcare expenditures per capita | $4959 | $5411 | $3935 |
| Expenditures on healthcare | Government: 78% Private: 22% |
Government: 77% Private: 23% |
Government: 83% Private: 17% |
| Size of medical device market (USD) | $14.5 billion (USD) | $26 billion (USD – 2014) | $9.5 billion (USD) |
| Number of hospital beds | 6.4 per 1000 people | 8.2 per 1000 people | 2.9 per 1000 people |
| Age distribution | 0-14 years: 19% 15-64 years: 72% 65 years and over: 19% (2015 est.) |
0-14 years: 13% 15-64 years: 66% 65 years and over: 21% (2015 est.) |
0-14 years: 17% 15-64 years: 65% 65 years and over: 18% (2015 est.) |
| Life expectancy at birth | Male: 78 years Female: 85 years |
Male: 78 years Female: 83 years |
Male: 78 years Female: 83 years |
| Currency | Euro (€) | Euro (€) | Pound sterling (£) |
Source: Emergo by UL
France ranks among the top five largest medical device markets in the world. France spends 3% of total health expenditure on medical equipment and supplies, and 0.3% of its GDP, which is average for a Western European country. The overall market is generally well developed; however, certain sub-sectors in the more innovative forms of technology still present opportunities for entry. While the public sector is the largest purchaser of diagnostic, therapeutic and surgical equipment, the private sector is also a very dynamic player.
The continuing deficit of the national health insurance funds has prompted new measures to control spending on medical devices, similar to those already in force for pharmaceuticals.
To export medical devices to France, US companies should either have a local agent/distributor or set up a subsidiary. Medical devices in the French market, whether imported products or domestically manufactured lines, are subject to the following requirements:
Current Market Trends
The medical market is likely to only see moderate growth, as it has risen at a very small, steady rate in past years. The medical manufacturing industry has seen entry of foreign companies; larger manufacturers are now subsidiaries of multinational groups.
Domestic production in several sectors of the French medical device market is meeting part of the demand, and is supplemented by imports, which now account for around 35% of consumption.
US companies can expect to face competition in this market from major global suppliers such as Siemens, Fresenius, Hitachi, Toshiba, Philips, and Smith & Nephew. Additionally, competition can be expected from French players such as Air Liquide, Asklé Santé, Coloplast, Landanger, Mediprema, Moria, Paul Hartmann, Peters Surgical, Proteor, Systam, Thuasne. France is home to many subsidiaries of American companies such as Abbott Vascular, Alcon, BD, Boston Scientific, 3M Santé, Baxter, Edwards Lifesciences, GE Medical, Johnson & Johnson Ethicon, Medtronic, St. Jude Medical and Zimmer.
E – Health in France
France’s new healthcare act adopted by Parliament in mid-2019 (based on the government’s plan ‘My Health 2022’) seeks to foster the country’s e-health readiness:
Streamlined governance, improved interoperability, and enhanced security are key focus areas
Electronic Health Records [EHR] will be rolled out nationwide after significant delay and will become the cornerstone of several e-Health platforms
Artificial Intelligence [AI] Health has been identified as a priority domain, and a data hub for the exploration of one of the world’s largest healthcare data sets has been established
Telemedicine, already strengthened through recent introduction of full coverage by the public health system, will be opened further to additional healthcare professions
With a higher than European average spending of 11.5% of GDP on healthcare and good health outcomes, France has been regularly lauded for the high quality of healthcare provided1. Yet, the country has often been perceived as a laggard in digitalization of the healthcare system.
Building on successive digital health policy efforts since 2010, France has significantly sharpened its focus to result in today’s global vision for a comprehensive national e-Health agenda, which puts the patient at the center. The ‘National Health Strategy 2022’, which was enacted as law in mid-2019, promotes, among other non-digital measures, the reinforcement of governance, security, and interoperability as well as the accelerated roll-out of digital health applications. It aims to stimulate innovation in digital care provision, notably telemedicine, and is supported by an investment program for increasing the digital readiness of the country’s hospital network.
Driven by the desire for closer coordination of all stakeholders, both public and private, a single ministerial delegation will take charge of all e-Health activities within the Ministry of Health. In addition, the national digital health agency (ANS) was created in December 2019 from its predecessor agency ASIP Santé to operationalize the government’s e-health strategy. In February 2020, the ANS published the overarching technical policy framework for the e-health services and platforms foreseen by the new legislation. This comprehensive framework will serve as a basis for subsequent enforcement ordinances by the ministry.
In particular, the ANS mission includes the continuation of the development and dissemination of frameworks for security and interoperability of health information systems. Since no standards from the interoperability framework have yet been completely enforced, facilitation of interoperability in EHR systems through a standardized language and coding for all providers and stakeholders remains a key priority.
Developments in the future
In the coming years, the government will release investments of 5 billion euros for the digitalization of the health sector. 3 billion of this is earmarked for the modernization of technical equipment and infrastructure.
According to the SNITEM association, the social security system will make savings above all in the area of medical devices. In particular, further savings will be made on investments by hospitals. This applies especially to public hospitals, as they account for 77 percent of health expenditure.
All in all, it remains to be seen that the reforms in France will also change the individual distribution structures, especially in the outpatient sector. Medical technology companies should be called upon to monitor this market closely in the coming months and react to changes accordingly. With a suitable strategic partner, market entry should be successful.
