Monday, September 14, 2009

Frances Health Care System

Health Care Abroad: France
By Anne Underwood AND Sarah Arnquist

Excerpts from an interview with Victor Rodwin Highlighting Europes best liked HealthCare system

Victor G. Rodwin is a professor of health policy and management at the Wagner School of Public Service at New York University and co-director of the World Cities Project.

Q.

In 2000, the World Health Organization ranked the French health system as the best over all in the world. Do you agree?

A.

I question the W.H.O. methodology, which has serious problems with data reliability and the standards of comparison. A study I would take more seriously is one published last year by Ellen Nolte and Martin McKee in the journal Health Affairs.

Q.

That finding implies that the French have good access to health care. Do they?
A.

On most measures, they do. They don’t do a better job of cancer screening than we do. But when it comes to timely access to primary care, the French are superb.

Q.

As I understand the French health care system, doctors are private, but patients are enrolled in national health insurance. Is it sort of like Medicare for all?

A.

Very much so. It’s not government run but government financed. Like Medicare and Social Security, it is funded by compulsory payroll taxes with some income tax contributions. But doctors work predominantly in private, office-based, fee-for-service practices, and there is a mix of public

Almost the entire population has some degree of private supplementary insurance, too, much like Medigap policies

Q.

So it’s not a single-payer system.
A.

That’s correct, but it operates much like one. In France, nobody has a choice of insurer for basic coverage. There are three major plans — one for most people who are employed (77 to 78 percent of the population), a smaller one for agricultural workers (4 to 5 percent), and another small one

Q.

If the French system resembles Medicare, does that mean that it also faces the problem of rising costs?

A.

Yes, all health care systems face the pressures caused by expensive new medical technologies and prescription drugs. Since there are no enforceable budget ceilings on French national health care expenditures, annual increases tend to exceed spending targets.

Q.

How do they control health care costs?

A.

Three ways. First, the government negotiates prices for doctors, hospitals and prescription drugs. Second, France has far fewer private health insurers, so the system requires less expenditure on administrative costs for marketing, underwriting and managing complex reimbursement rules. Third, France’s investor-owned insurance sector is far smaller than in the United States, and its medical-industrial complex is far less powerful, so the government can negotiate stronger cost controls.

Q.

But you also said the French have no choice in their plan. Americans seem to want choice.

A.

The French have no choice among insurers for the basic plan. But French National Health Insurance gives them more choice of doctors and hospitals than the average American has.

Q.

Medical malpractice has become an issue now in the debate over health care reform in this country. How much of every health care Euro in France goes to pay for malpractice costs?
A.

I’ve never seen such an estimate, but even in the U.S. this figure is much smaller than people generally believe — less than 1 percent of health care expenditures.

Q.

What key lessons can the United States learn from France?
A.

The French health system demonstrates that it is possible to achieve universal coverage without a government-run system that regulates how doctors practice medicine.

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