They're that. There is also the massive inefficiency of of having non-universal system, due to administrative operational complexity cost and marketing spending.
France is one of the less efficient in europe due to having a dual system, the universal part is very efficient (5% of budget spend on operational costs), the other part, operated by competing organisms, loses up to 20% of their budget on marketing, plus the general operating cost of having a multi tier for insurance coverage.
France is one of the less efficient in europe due to having a dual system, the universal part is very efficient (5% of budget spend on operational costs), the other part, operated by competing organisms, loses up to 20% of their budget on marketing, plus the general operating cost of having a multi tier for insurance coverage.