Public Funding and Out-of-Pocket Payments for Wheelchairs: A Comparison among France, England, Belgium, and Sweden

QES n° 296
2025/01

ABSTRACT
Access to wheelchairs has been facilitated in most European countries, but there is no common policy with regard to the prices and reimbursement of these devices. There is a clear distinction between the countries that exclusively entrust wheelchair distribution to the private market and those that distribute them via public systems. While the full reimbursement for wheelchairs by National Public Health Insurance from 1 December 2025 has just been announced, our study compares - prior to the French reform's implementation - the range of prices and public funding for wheelchairs in France with those of three European countries, which have also seen changes in the way they are financed: Belgium, similar to France, distributes wheelchairs via private markets, whereas Sweden and England provide wheelchairs through public markets.
All countries provide basic manual wheelchairs without out-of-pocket payments for users. However, public funding per wheelchair is lower in public systems (approximately €370 in Sweden and England) than in private markets, where lump-sum payments apply (approximately €600 in France and €775 in Belgium). Before the reform, France was the only one of the four countries studied that did not provide an active wheelchair that was entirely covered, including entry-level models. The English National Health Service (NHS), the Swedish regions, and the Belgian regions all provided an entry-level version of these wheelchairs. The entry-level power stand-up wheelchairs, which cost approximately €8,000, are wholly covered. However, for high-range models, which can cost as much as €25,000, the user out-of-pockets are high in most countries. Although France authorises partial funding of all the approved models, other countries enable (with a more limited offer) people to purchase wheelchairs with fewer out-of-pocket payments, with the support of a single public payer. In France, before the reform was introduced, additional extra-statutory funding was available to reduce user out-of-pocket payments, but they were subject to conditions and could vary with the départements.

See also Questions d'économie de la santé n° 296 in French: Financements publics et restes à charge des fauteuils roulants : enseignements d'une comparaison France, Angleterre, Belgique et Suède.