Monday, August 24, 2009

The French Healthcare Explained to the Americans (in a nutshell)

Following the false rumors I hear about healthcare in Europe, I think it is more than appropriate for this blog to say a few things about the French healthcare system in order to debunk the myths propagated by Foxnews and its clique.

Last night, Sean Hannity had a special entitled “Universal Nightmare” during which he lashed against socialized and single-payers of Canada, Britain and France. It must be noted, for starter, that, contrary to what MrHannity said, France does NOT have a single payer system. France utilizes a mix of government and market-based systems.

Only about 60 to 90% of most health care costs are covered by the public system and the remaining is covered by private insurers and 92% of the French have them.

In case of costly or long-term ailments (Cancer, Aids, etc..) however, the public system covers 100% of the costs (in a nutshell, the sicker you are, the more coverage, care, and treatment you get).

It should also be noted that most of those private insurers are actually non-profit mutual insurers (referred to as “mutuelle” in French) and so no one is denied insurance (on the ground of pre-existing conditions or other) and no one is asked about their medical background. Those who can’t afford private insurance have "universal health coverage".

99% of French residents are covered by the national health insurance scheme and about 92% of French residents have complementary private “mutuelles”.

Most of the funding is from a 13.55% payroll tax (employers pay 12.8%, individuals pay 0.75%). There is a 5.25% general social contribution tax on income as well. Thus, there is an approximately a 18.8% on employees for health insurance. There are also dedicated taxes which are assessed on tobacco, alcohol, and pharmaceutical company revenues. (source Healthcare Economist)

The French can choose their doctor as they please, even if recently, a “managed care” practice has been adopted, where patients have a “preferred doctors” who acts as a gatekeeper for (some) specialists.
The freedoms of diagnosis and therapy are highly protected and guaranteed by the system but American physicians earn about twice as much as French physicians. That, however, is somewhat compensated by the facts that there is hardly any practice liability (the legal system is tort-averse) and medical school, however competitive is tuition-free. Finally, there is usually no non-medical personnel – the billing goes directly to the Sécurité Sociale and reimbursement is now electronic.

There is no waiting list and if you go to the Emergency, and if you are seriously ill, you’ll be taken care of immediately without filling in papers or being asked anything. (however, if you go to the ER for something minor, you may have to wait for a while).

This is not to say that the system is perfect - its greatest drawback is cost :
France’s medical costs have been rising sharply, which has led to higher taxes on employers and workers and the national insurance system has been running deficits since 1985 — it currently stands at $13.5 billion. (Wall Street Journal)
Reimbursement of some medication is not as good as it used to be and some people have been complaining. I tend to think that it is also because the French have been pampered and they may need to toughen up. But they will defend their current system at any cost because it has produced results!
Access to health care appears to have produced a healthier nation: France’s infant death rate is 3.9 per 1,000 live births, compared with seven per 1,000 in the U.S.. The country has more hospital beds and doctors per capita than the U.S., and a markedly lower rate of mortality from respiratory disease. And France spends less (10.7% of gross domestic product) on health care than the U.S. (16% of GDP). (WSJ)
With the rising cost, there will definitely need to be some adjustment to be made but I believe that the French are very attached to their healthcare because it has proved to work well, and there will be ready to support it, even it becomes very costly. In the long run though, it can save a lot of money, if nothing else, because people don't wait to be entirely sick or old to get treated.
It is basically a question of priority for a society and what it values as most important. To the French health and education are priorities above any other.


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