France must make big changes to its health system in order to cut waste and increase efficiency, a government-commissioned report is warning.
Plans for spending cuts have drawn protests from health workers
The report says citizens must pay more and doctors must alter their behaviour.
Failure to do so could add 66 billion euros a year to France's public budget deficit by 2020, it adds.
The warning comes after thousands of health workers protested on Thursday over staff shortages and the "creeping privatisation" of the health system.
The report was written by the High Council for the Future of Health Insurance, an advisory body set up by the government as it prepares to introduce healthcare reform legislation in June.
It includes representatives from the health insurance industry, trade unions and medical professionals.
Average French GP prescribes drugs worth 260,000 euros a year
The French use three times as many antibiotics as Germans
They use twice as many anti-cholestorol drugs as Britons
A fifth of health spending goes on pharmaceuticals
The report was given to the Health Ministry on Friday, but details were leaked by the Reuters news agency which saw a copy.
The standard of care provided by French doctors is ranked among the best in the world, but the report says the system is "badly regulated and badly governed".
"The High Council believes that general confusion over who is in charge of what partly explains the excesses," it says.
"Everyone - institutions, healthcare professionals and social security contributors - will have to change their behaviour."
Higher insurance payments?
The report says French general practitioners prescribe on average 260,000 euros' worth of drugs a year.
It says the French consume three times as many antibiotics as the Germans, and more than twice as many anti-cholesterol drugs as the British.
Health spending nearing 9% of GDP
Projected healthcare deficit this year - 10.9 billion euros
Deficit in 2010 if nothing is done - 29 billion euros
Healthcare deficit to account for 20% of total public deficit this year
The council also highlights the CSG welfare levy - a charge paid by workers, the unemployed and pensioners - as an area for possible reform.
"The High Council is unanimous in its refusal to turn to massive indebtedness to cover the growth in health insurance expenditure," the report said.
"The CSG, with its large base and the principle of proportionality that underpins it, could seem like a possible answer," it said.
The council said even a structural shake-up of the system would not necessarily rule out the need to raise further revenues.
Prime Minister Jean-Pierre Raffarin, which set up the council last October to advise the government on healthcare reform, said last week the government had not been planning a rise in the CSG as part of the healthcare reforms.
The report says an ageing population and the high cost of advanced treatments will help push health spending past 9% of gross domestic product - one of the highest levels in the world.
Experts have already warned that a projected healthcare deficit of 10.9 billion euros this year could rise to 29 billion euros by 2010, unless action is taken.
Number of doctors per 1,000 people
Italy - 4.1
France - 3.3
Germany - 3.3
UK - 2.0
Japan - 1.9
Source: British Medical Association. Figures for 2000
Looking further ahead, the report says the deficit could rise to 66 billion euros by 2020.
Health Minister Jean-Francois Mattei has already put forward a plan known as "Hospital 2007" proposing management reforms and a new emphasis on cost assessment.
Problems in the French health system were exposed last year, when a heat wave killed around 15,000 mostly elderly people.
There was also a bed shortage in hospitals in December, when a nationwide flu and bronchitis epidemic broke out.