The 1979 reform of the health system reduced public funding for hospitals from 90% to 15%. Hospitals must be 85% self-financing. As a result, patients have to pay for their health care. Thus, many people can no longer afford to go to hospital for treatment. In 2005, 75% of the rural inhabitants and 45% of the urban inhabitants stated that they could not afford to go to hospital for economic reasons. Urbanization and the abandonment of the countryside mean that 80% of medical resources are located in cities. In 2009, health expenditure represented 4.96% of GDP, or 72.1 euros per capita. Public funding represents 24.7% of total health expenditure. In 2009, health expenditure represented 4.96% of GDP, or 72.1 euros per capita. Public funding represents 24.7% of total health expenditure. In comparison, public funding in the United States is 50% and it is nearly 80% in Japan and European countries.