.gif)
The French flag
This article continues a comparative look at countries that have implemented the Bismarck model of health care, which emphasizes a mixture of private and public administration to deliver services. Thus far, we have discussed the German and Japanese systems of health care.
This piece will focus on health care in France, where social safety net programs are far more expansive than in the US; but whose health care system bears a closer resemblance to our own than the socialized, government-run systems in Britain and Canada. The French also earn consistently higher marks on health care measures than the U.S.
Read: A history of health care in the U.S.
Read: Distortions in the public debate on health care
Read: The Patients’ Choice Act
Read: The Affordable Health Choices Act
Read: The Public Option
Read: The Canadian health care system
Read: The British health care system
Read: The health care system of Taiwan
Read: The German health care system
Read: The Japanese health care system
According to the American Journal of Public Health, “In France, the commitment to universal coverage is accepted by the principal political parties and justified on grounds of solidarity – the notion that there should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk.”
In the United States, our system is the exact opposite. If you get sick in America, there are people who will search your medical records in search of a reason to deny you coverage – sometimes retroactively. In America, insurers rely on the premiums of their healthy customers to subsidize their profits and advertising costs, as well as the administrative burdens behind their intense denials of care – indeed, we all pay more, so that the profit sector is able to withhold, delay, or deny payment in order to satisfy shareholder demands. The system is designed to deny care to those who need it the most, which is an inherent failure that the free market cannot, or will not address on its own.
The French system lends valuable insight into our own, since it better integrates private insurance with a universal health care system.
France
The frequently cited study by the World Health Organization that compared industrialized nations on the basis of health care, ranked France number one; in contrast, the US held the title of 37th. Another study that focused on 19 industrialized nations by determining an “amenable mortality,” or the number of deaths that could have been prevented through quality health care, also ranked France first, and the U.S. last.
According to Business Week, the infant mortality rate in France is 3.9 per 1000 compared to 7 in the U.S. The life expectancy in France is two years greater than in the U.S. The French have more hospitals and doctors per capita, and much lower rates of diabetes, heart disease, and preventable deaths (31 in France compared to 61 in the U.S.). In addition to better health outcomes, there is no perception that health care is rationed; the French have no gatekeepers and are free to choose any doctor, and see any specialist they want. Physicians are free to provide any care that they deem medically necessary.
The French system offers extraordinarily comprehensive prenatal and early childhood care. In France, mothers and their children receive basic preventive care through a network of community-based health care facilities called Protection Maternelle et Infantile. Children are cared for by a team of pediatricians, nurses, midwives, psychologists, and social workers, and if a parent neglects to take their children in for regular checkups, a social worker will visit the family at home. Expectant mothers receive monetary rewards for attending their pre- and post-natal visits. Child care is also subsidized and affordable for working parents. As Daniel J. Pedersen, president of the Buffett Early Childhood Fund, notes “It’s based on the practical idea that high-quality investments made at the start of a child’s life will pay huge dividends to both the child and society in the future.”
According to the AJPH, national health insurance (NHI) “forms an integral part of France’s social security system, which is typically depicted—following an agrarian metaphor—as a set of 3 sprouting branches: (1) pensions, (2) family allowances, and (3) health insurance and workplace accident coverage.” The first two are managed by a single national fund, while the third is run by three main NHI funds: those for salaried workers, farmers and agricultural workers, and the independent professions. In addition, there are 11 smaller funds for workers in specific occupations and their dependents.
All of the plans are private, but operate within a standard framework and are heavily regulated by the government. They operate through a network of local and regional funds that handle reimbursement to health care providers, monitor for fraud and abuse, and provide customer services for their insured.
Health insurance is compulsory, enrollment is automatic based on occupational status, and the funds are not allowed to compete with each other by lowering premiums or denying coverage. The health care system in France is composed primarily of private practice operations for ambulatory care, and public hospitals for acute institutional care. Another distinguishing feature noted by the AJPH is its proprietary hospital sector – the largest in Europe – and which is accessible to all insured persons.
Basic coverage includes services including hospital care, outpatient services, prescription drugs (including homeopathic products), thermal cures in spas, nursing home care, cash benefits, and to a lesser extent, dental and vision care.
Physicians in ambulatory care are paid directly by patients, who are then reimbursed a fee that is negotiated through the funds, trade unions, employers, and provider associations. For inpatient hospital services, there are annual global budgets negotiated every year between hospitals, regional agencies, and the Ministry of Health, as well as per diem reimbursements. Prices for prescription drugs are set by a commission that includes representatives from the Ministries of Health, Finance, and Industry.
The NHI typically covers about 70 percent of health care costs. There are no deductibles, but moderate co-pays. In addition, more than 90 percent of the population subscribes to supplementary health insurance to cover these costs, as well as other benefits not covered under NHI. Chronic diseases and other critical ailments are reimbursed in full and cancer patients are treated for free. As mentioned above, in France, the more care you need, the less you pay.
In order to achieve such laudable results, the French pay more in taxes than Americans – about 21 percent of their income (employers pay half of that) – but they also receive far more for the tax dollars they pay. Beyond taxation, France has held down costs by negotiating far lower rates with physicians than their American counterparts receive – they earn about one-third of what US physicians do; about $55,000 per year. However, as Business Week points out, French doctors’ medical school is paid for by the state, malpractice premiums are a fraction of what they are in the U.S., and the government pays two-thirds of the social security tax for most physicians – a tax equivalent to 40 percent of income.
Nonetheless, cutting physician reimbursement rates does not reduce the demand for care, and is not a sustainable method of reducing costs over the long-term. Compared to its European counterparts, France’s health care costs are relatively high at 10.7 percent of GDP – though they are still much lower than the 16 percent we spend in the U.S.
Physicians manage to earn more by increasing their patient load, or by ordering unnecessary procedures – a problem common in the U.S. as well. The French system has been running deficits since 1985, which in 2007, was $9 billion. Officials are considering implementing health maintenance organization techniques in order to more effectively contain costs. For example, patients are now required to register with a general practitioner before visiting a specialist, or otherwise receive less reimbursement – similar to the U.S.
Nonetheless, 65 percent of citizens express satisfaction with the system, compared with just 40 percent in the U.S. As the AJPH notes, “It is the outcome of sociopolitical struggles and clashes among trade unions, employers, physicians associations, and the state.” Successes were not achieved overnight – neither was universal care. It occurred incrementally, in successive stages that progressively brought more individuals into the fold – and operates very similarly to Medicare. The indemnity model encourages patients to be vigilant of their care, while remaining conscientious of their consumption.
France offers a model of publicly and privately administered and delivered health care that reflects the type of system that could emerge in the U.S., but the government must ensure that reform includes the appropriate incentives and oversight to maximize efficiency.
The next article will explore Switzerland’s health care system.
To receive notification when the next article of the series on health care reform is published, click on the “Subscribe” link below.
*If you would like to submit a health care story, with the possibility of seeing it published here, please send me an email message at jennyk1981@gmail.com.
Copyright ©2009 Jenny Kakasuleff
For more info:
The French Lesson in Health Care
The Health Care System Under French National Health Insurance
Health Care Lessons From France
Universal Health Coverage and Victims of the US System
French health system worse, but still better than British: study
Comments
You gotta GIVE IT BABY WHY DON'T YA GIVE IT UP, NA-NA-NA-NA-NA NOW GIVE IT UP. Why would anyone want to emulate anything from France, Bwah-hahaha, well the language does sound sexy on a woman, remember that chick in that Rod Stewart tune 'Tonights the Night'. Give it up WEANER, the people have spoken, and no we don't need no stinking European-Style Socialism.
By your loose definition of 'socialism' we are in fact a socialist country... because our health care model is already a blended model. IE Medicare and Medicaid, Tri-Care, SCHIP etc are all different public insurance schemes that compete with the private sector. So whom then are we emulating, if indeed were already about 50% there anyway?
I CAN'T GO FOR THAT, NO CAN DO, I CAN'T GO FOR THAT, NO CAN DO.
Did you just seriously ask why anyone would want to emulate a system which you just finished being informed that that system outperformed the system in the US by vast margins pretty much across the board?
Because basically you just said "Hey everyone! I can't read!"
Either that or you said "Hey Everyone! I'm an unthinking bigot who is incapable of rationally considering the merits of anything if it comes from the French!"
Or option C.. both.
So... which one would you prefer we think it is?
You ever hear the expression "don't believe everything you read?" You know like unemployment in the US is at 9.5%, bwah-hahaha, yeah right.
heh,heh,heh... KC said "bigot", heh, heh,heh.
I like french fried pertators with mustard, they good alright. Alright Den.
Jenny,
What do some of your readers do all day ? I swear, if I was as uninformed as some obviously are, I would probably stay in my room all day playing video games and watching fox news while I listened to Lush Rimbaugh. Wait, I think I figured it out all by myself.
Never mind.
I'm one of the 68% of Americans who is satisfied with my health care, if you're not, the only thing I can say is pack your bags and try elsewhere. So sorry get over it, that's life.
obamacare
R.I.P.
Mark, i am certain that you and my dad have more in common than anyone can ever imagine. lol
The United States Is The Best For Health Care But for The Ones Who Do Not Have Health Care is When Universal Coverage Should Come In To Play . We Have Medicare And Medicaid But what is Inpoertant also is Universal Coverage For All of us On Drug Prescriptions We should Only Pay a penny like other Countries And also yet to allow the ones here who do not have Health Care to have Full coverage with out losing there homes !!!!! Nunziio Bagliere of Syracuse N.Y
Medicaid, and medicare are not impotent. i have seen it work for for my own family members. Paying only a penny, or whatever is a pipe dream. i imagine that we are all going to have to pay, not as much as now, but still, we all need to be patriotic, and be willing to kick in. you can write, or call your represenatives, on the national level, on the state and local level, you can attend city council meetings etc. There is alot we can do to get involved.
"...the people have spoken, and no we don't need no stinking European-Style Socialism."
The people spoke when they elected Barack Obama - you lost - get over it. We are already socialists - we have been redistributing tax dollars for decades - get over it.
When the right has to stoop to levels so low that they're trying to convince people better care will kill them - you are losing the battle. Armed with facts, you would all be laughed off stage, considering you have none. Stick to the rhetoric; the big people will reform health care without you=)
Bonsoir,
NO WE WON'T/JUST SAY NO!
Merci
Au Revoir
Ive lived in France, i was homeless in Paris for a spell. Well i have to meet my publisher at the socialist book of the month club. Orwell did say that he didnt beleive that socialism would ever be embraced in the United States. He believed that because he thought that americans were rude and stingy
Jenny quips " we've been redistributing tax dollars for decades-get over it." Yeah and we've all seen what that's done for the country, have you paid a visit to Detroit lately? Speaking of the French, have you taken a stroll in Nawlins,La. lately? There's your SOCIALISM at it's FINEST. Damn you're beyond repair, totally gone, FUBAR to the 3rd degree, "Ooh, baby, baby, won't you come my way, Ooh baby, baby you're old enough to dance the night away."
Now you are blaming the liberals for the the condition of New Orleans. That doesetn even merrit a response. I think any liberals reading this comment thread will break a rib laughing at the idiocy of the right. stupid fat white people, ignorant, no education. just plain dumb.
I break a rib laughing at LIEberals blamin' others all the time. New Orleans was a cesspool long before Hurricane Katrina, and you saw how they reacted during the hurricane, expecting someone else to save them, robbing, raping, assaults were all the order of the day. Contrast that to the many areas outside Nawlins, where people were organized and not waiting on the gubmit to come in and help, they were helping themselves. Brad you're FUBAR to the 3rd degree! Having lived in Florida for decades you're warned days in advance of major hurricanes, as were the IDIOTS who stayed in the Crescent City, who despite all warnings to get out of the city, chose instead to stay and loot and rob. LIBTARD. "All the way from Bourbon Street to Esplanade, They Sashay By, They Sashay By."
Get a load at Bradtard talking about STUPIDITY. Go visit some of your illiterate black boys in Detroit, you stupid hayseed hick.
Mark, now you are calling me a hayseed hick and claiming to have lived in florida for decades. funny how all of Marks alter egos are older than moses, and sound like and old negro spiritual. I do live in a section eight ivory tower.
the conservatives cannot handle that fact that they have absolutely no foothold whatsoever in todays public agenda. have fun playing world of warcraft, and jerking off
I'm not Mark, you IGNORAMUS LIBTARD. Mark has pawned you so many times you can't get him out of your head, you niave GOOBER.
This is a comment board on a political blogsite. why is there so much hostility. Its like someone speakes their mind, and a conservative butthead comes back and calls them names, or some other banal crap. If you want to get a virus on your computer, follow some of the link that these losers are posting on thier comments
Sorry "im not Lisa" i would be offended if i were mistaken for mark. to think that he thought that Orwell was a conservative. He cant handle the fact that he has been pushing the work of a hardcore socialist like Orwell
Don't start none, won't be none SHRIV. GIT-R-DONE!
Once again this is a comment board, on a political blog, not D&D. This a forum to exhcange ideas and opinions.
Jenny says: the big people will reform health care without you
Obama Open to Creation of Health Cooperatives
President Barack Obama may accept nonprofit health-insurance cooperatives in place of a new government-run plan as long as consumers are guaranteed more choice and competition in buying insurance, a top aide said.
"We would be interested in that" if those conditions are met, Nancy-Ann DeParle, director of the White House Office of Health Reform, said in an interview with Bloomberg Television’s "Conversations with Judy Woodruff" airing today.
"IN PLACE OF A NEW GOVERNMENT RUN PLAN"
We are being heard and it is showing.
I am ALL FOR "nonprofit health-insurance cooperatives" which should be non employer based. Employer based is stupid. We should not have to change in a change of jobs. NO other insurance is employer based.
Co-ops should be a better plan than any I have seen so far. Portable and anyone should be eligible regardless of pre-existing conditions. Peo
Brad says: Now you are blaming the liberals for the the condition of New Orleans.
YES. Democrats ran the STATE AND NEW ORLEANS for decades!
Mark, oops i meant Que, so you are saying that the republicans were not responsible in any way for the chaos that took place in new orleans in 2005
Nagin and Blanco were clueless and like deer in the headlights.
Brad says: so you are saying that the republicans were not responsible in any way
You leftists are alike. You assume far to much from a few words typed by someone. What I typed can in no way infer anything other than what it said. It was just a factual comment.
Noting other than what was typed was meant.
Until you stop THINKING what other people mean instead of looking at WHAT THEY TYPED you will be confused and ignorant!
so by not answering my question i assume that you concede that the Republicans should accept their share of the responsibility, in the New Orleans disaster. do the words "heckuva job Brownie" mean anything to you "que"
this is coming from the guy who thought Orwell was a conservative. lol
Brad says:
this is coming from the guy who thought Orwell was a conservative. lol
I NEVER typed any such thing. I responded to your question. Thats all.
And yes Brad, I believe ALL of government has failed the American people. From the mortgage mess which started the whole thing to trying to do everything from cradle to grave.
"Brownie" should accept his role for the chaotic aftermath in New Orleans after hurricane Katrina. Stop being afraid to blame minorities and blacks Bratford, you cowardly LIEberal.
Hey Bratford why don't you be true to your cause and help out the minority community and do some traveling at the same time. I mean you need to get out of that cow town Indianapolis, and experience that cosmopolitan life you liberals enjoy so much. Maybe you could move to the inner cities of the Big Easy and Motor City and help out with the illiteracy in those communities. I hear the illiteracy rate in the city of Detroit is 47%, S O S Bratford.
Roth (Hagar is better btw): Do you hate America? If you think socialism has ruined it, I hear the socialist quotient in Somalia is extremely low - no taxes - but you'll be fighting pirates for work. Pick your poison.
Where do you get "socialism" from New Orleans? That place is overrun my PRIVATE, PROFIT-SEEKING CONTRACTORS! I'll admit, they've really messed the place up - but they aren't socialists. New Orleans is CAPITALISM at its finest! So glad you brought it up!
No Jenny I'll pass on Somalia, little too dark for my taste, but it's probably a good place for you and Bratford to work some liberal magic.
"YES. Democrats ran the STATE AND NEW ORLEANS for decades!"
Now I'm confused! Pat Robertson said GOD was who brought the hurricane, but you're saying that liberals did that too! OMG! (rolls eyes) Please explain for us all - so we do not have to infer - how you believe liberals are responsible for what's going on in N.O.
It was all Bush's fault in hurricane Katrina. Just because you have the country to run, you shouldn't depend on local gubmint to handle their own catastrophes. I agree with that cRapper Kanye West, "Bush doesn't like black people." Warning people days in advance and supplying them with transportation is not good enough, we are ENTITLED in the LIBTARD BILL OF RIGHTS to have everything done for us, and always blame others.
Keep listening to FOX and Limbaugh - don't bother to actually look into what happened in New Orleans. We wouldn't want your head to explode when you realize you're being spoon-fed lies by your favorite "commentators." Funny how you guys never look at the motivation behind the sources of your info. - Glenn Beck hasn't gotten more radical with age - he knows how to manipulate his sheeple.
its a relief that the conservatives are on the outside looking in for a change. These fools had their chance and the blew it big time. eight years of george bush probably set the country back twenty or thirty years. and it appears as if they have no real strategy for 2010, besides trying to blame obama for everything going back to the chicago fire.
I'm sure people like you and Bratford can help cleanup ole Crescent City there Jenny. Start packing, best of luck!
Au revoir
Good luck in 2010. it looks like the republican have no new ideas, no plans, and no strategy. it looks like 2010 will be a cake walk, and Obama will easily be elected to a second term, followed by eight years of hillary, or maybe evan Bayh, or Bill Bradley. Keep on blaming the liberals for everything, and thinking up nifty new ways to compare obama to hitler, i will keep on casting my vote for the winning side.
Keep listenong to Maddcow and Overbite.
WE all know Jenny's opinions are the only one that are correct. She is the only one to do any research. She has told us that our research and opinions are worthless because we do not use her sources or her logic.
What a superiority complex you have.
What death panels?
"NHS failure on Down's screening kills healthy babies
Missed target means only one in three hospitals offer pregnant women the best test, admits screening chief"
www.guardian.co.uk/society/2009/may/16/health-nhs
Oh, THOSE death panels.
"Patients forced to live in agony after NHS refuses to pay for painkilling injections"
www.telegraph.co.uk/health/healthnews/5955840/Patients-forced-to-live-in-agony-after-NHS-refuses-to-pay-for-painkilling-injections.html
"Elderly left at risk by NHS bidding wars to find cheapest care with reverse auctions"
www.timesonline.co.uk/tol/life_and_style/health/article6401002.ece
"
'I said to the nurse, please feed her'
Pauline Pringle's mother went into hospital for a hip operation and came out close to starvation. And as Blake Morrison reports, hers is not an isolated case"
www.guardian.co.uk/society/2006/jan/07/health.familyandrelationships
"Suddenly a robust, cheerful woman of 79, whose only mobility problem had been climbing stairs, began to talk of never leaving hospital again but of being "laid out on a marble slab" - and when the hospital asked for our permission not to resuscitate her should she lose consciousness, we realised this was no paranoid fantasy."
Jenny says: That place is overrun my PRIVATE, PROFIT-SEEKING CONTRACTORS!
And the problem is? What do you have against companies making a profit?
Next time you are looking for a job, go to a company that DOES NOT make a profit! See how that works to feed your family.
I'm feelin' drunk, juiced up and sloppy, aint touched a drink all night. I'm feelin' hungry, can't see the reason, just ate a horse meat pie. Looks like we need some obamacare mate.
See Hagar, even Que agrees that New Orleans isn't run by socialists. Thanks for the clearing up he confusion, Que.
Pages
Got something to say?
Examiner.com is looking for writers, photographers, and videographers to join the fastest growing group of local insiders. If you are interested in growing your online rep apply to be an Examiner today!