The French Healthcare System Bill Berlin October 19th, 2013 Ferris State University

The Basics All legal residents have health insurance, provided by “couverture maladie universelle” or universal health coverage. Social security covers 80% of the population. Two other funds are available for the self-employed and agricultural workers.

The Basics cont’d Health insurance is mandatory, no one is exempt. 90% of French residents also purchase supplemental insurance. Reimbursement is regulated by the state. Financing comes from employers, employee contributions and personal income taxes.

Hospitals Public hospitals account for the majority of hospital beds. Also responsible for ongoing care, training and education Private hospitals are profit driven. Generally focus more on surgical procedures, depend on fee-for-service as a means for funding.

Coordinated Care Every patient has a general practitioner registered with the state as that patient’s primary healthcare provider. The general practitioner is responsible for making referrals to specialists (an orthopedist for example). Exceptions are made for ophthalmologists, gynecologists and dentists. A patient does not need a referral from their general practitioner to be covered by the state.

Reimbursement Again, reimbursement is covered by the state. On average, patients are reimbursed: 70% for an office visit. 80-95% for surgery 70% for x-rays, dental care and home health care. 95-100% of costs associated with pregnancy and childbirth 15-65% for medications, depending on type.

Reimbursement cont’d Residents making below a certain income are eligible to receive 100% reimbursement of healthcare expenditures. Pictured at right is the carte vitale, which patients must present when receiving health services. This card forwards all healthcare encounters to the patient’s health insurance fund.

Physicians There are 3.3 active physicians per 1,000 population. The majority of physicians specialize in general practice. Medical school is paid for by the state. Because of a strict fee schedule, French physicians tend to make much less than their global counterparts (about $55,000 US).

Global Comparision In 2000, the World Health Organization ranked France the number one healthcare system in the world. Although some of the criteria used was highly criticized, data such as infant mortality and patient satisfaction is impressive. Unlike other countries with universal healthcare, citizens do not voice complaints about healthcare being “rationed”.

The Pros Healthcare is easily accessible to all residents Testing, such as labs or radiology, are quickly obtainable. Patients have the freedom to choose own physicians, and may select public or private hospitals (for a slightly greater out of pocket fee). More government oversight on healthcare. France has a higher population health status in comparison to the rest of the world.

The Cons Healthcare accounts for 11.2% of France’s GDP. 20% of employees’ pay deducted for social security fund. Because of the French “lassiez- fare” sentiment, there can be a lack of consistent quality care. Physicians are poorly paid in comparison to other countries, leading to tension and strikes.

French vs US Healthcare Healthcare accounts for 11.2% of GDP. National Health Insurance coverage increases for severe and chronic illnesses. Private hospitals account for only 36% of hospital beds. Healthcare accounts for 17.9% of GDP. Out of pocket expenses go up as a Medicare patient’s healthcare costs increase. Private hospitals account for more than 80% of hospital beds.

French vs US Healthcare cont’d Non-physician personnel per hospital bed- 1.9. Healthcare associated costs per capita- $4,952. Deaths among people less than 75 years old from heart attacks, strokes, diabetes and bacterial infections- 55 per 100,000 people. Non-physician personnel per hospital bed- 5.7. Healthcare associated costs per capita- $8,608 Deaths among people less than 75 years old from heart attacks, strokes, diabetes and bacterial infections- 96 per 100,000

Implications for US Healthcare Reform US spends almost double per capita on healthcare than France, but has much poorer health outcomes. France has contained costs much better than the US. Although France spends more on healthcare than many countries, their use of health care services is also much greater. The French healthcare system shows it possible to have universal healthcare without a single-payer system.

Quiz What percentage of the population has health insurance in France? Name one specialty a patient does not need a referral from their general practitioner to see. What is the average salary of a French physician? What is the card called a patient presents at every healthcare encounter? How much does France spend on healthcare per capita? What is one problem a French citizen may have with the healthcare system?

Bibliography http://data.worldbank.org/indicator/SH.XPD.PCAP http://www.medicalnewstoday.com/articles/9994.php http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/