Diary

National Health Care today France

France

“In the movie Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba.

I have not seen the movie.  I wonder if Sicko showed:

  1. The problems inherent in the French system
  2. 85% buy supplementary private insurance
  3. People pay first and are reimbursed
  4. Considering HMO type cost containment’s are in the plan (some already exist)
  5. France has run away health care inflation

That’s not to say the French have solved all health-care riddles. Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization (HMO) tactics to rein in costs. [1]

Subscription to the general French social security system (except in some specific cases) gives rights only to the basic health insurance coverage which reimburses usually only part of medical expenses. [2]

Regardless on whether you are insured in France or in your home country, you are generally required to pay medical expenses as they occur, e.g. when visiting a doctor, buying prescribed medicines and for medical tests. Then you can ask to be reimbursed by your health insurer.

A general doctor may charge from €20-25 for a consultation, a specialist €25-30. Fees will be higher at night or the weekend – a home visit will also cost more.

Types of payment vary: doctors usually prefer payment by check and some organisations might not accept cash. Only in some cases – such as some hospitalisations or if you are covered by specific heath coverage – you may be exempt from advance payment.

If you are subscribed to the French social security, you need to send a completed form (feuille de soins) to your CPAM (Caisse Primaire d’Assurance Maladie). Reimbursement takes usually 2-3 weeks and you can check on-line on www.ameli.fr (you should receive access information in the documentation provided by CPAM).

If you have a Carte Vital and the doctor (or a healthcare organization) is linked to the social security system, it is possible you may only pay the non-reimbursable part instead of having to claim it back afterwards.

For some medical costs (e.g. dental or orthopaedic prostheses), you must get prior approval from your CPAM to ensure subsequent reimbursement. This is why most people – nearly 85% of the population in France – choose to take a complementary private insurance (mutuelle, assurance complémentaire). This additional coverage covers partly or completely the percentage of medical costs not paid for by the general social security system. Some employers pay for some or all of an employee’s supplementary coverage. In our directory, you find a list of some mutual heath insurance organizations. [3]

France must make big changes to its health system in order to cut waste and increase efficiency, a government-commissioned report is warning

‘Badly regulated’

The report was written by the High Council for the Future of Health Insurance, an advisory body set up by the government.

  1. Average French GP prescribes drugs worth 260,000 euros a year
  2. The French use three times as many antibiotics as Germans
  3. They use twice as many anti-cholestorol drugs as Britons
  4. A fifth of health spending goes on pharmaceuticals

The council said even a structural shake-up of the system would not necessarily rule out the need to raise further revenues.

  • Health spending nearing 9% of GDP
  • Projected healthcare deficit this year – 10.9 billion euros
  • Deficit in 2010 if nothing is done – 29 billion euros
  • Healthcare deficit to account for 20% of total public deficit this year

The report says citizens must pay more and doctors must alter their behavior.

The council said even a structural shake-up of the system would not necessarily rule out the need to raise further revenues..[4]

The council also highlights the CSG welfare levy – a charge paid by workers, the unemployed and pensioners – as an area for possible reform. “The High Council is unanimous in its refusal to turn to massive indebtedness to cover the growth in health insurance expenditure,” the report said. Problems in the French health system were exposed last year, when a heat wave killed around 15,000 mostly elderly people. There was also a bed shortage in hospitals in December, when a nationwide flu and bronchitis epidemic broke out. [5]

To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don’t have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that’s typically 40% of income.  Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation.

[ I always wonder about health cost statistics given from governments.  Because paying for medical school and paying two-thirds of the doctor’s tax, make the system run, it should be included in the cost of health care.  Without such payment schemes the system would not work so therefore, it is part of the cost of health care. The USA Medicare administration hides costs, and I have the feeling France doesn’t include the costs in their “cost of health care”]

Many French doctors, in fact, earn more by:

  1. Increasing their patient load, or
  2. Prescribing more diagnostic tests and procedures

So far France has been able to hold down the burden on patients through a combination of price controls and increased government spending, but the latter effort has led to higher taxes for both employers and workers.

That’s why France is gearing up to make changes. It already requires patients to register with a general practitioner before visiting a specialist, or else agree to a lesser reimbursement, much like many U.S. insurance plans.[6]

French doctors go on strike to demand reintroduction of compulsory out of hours work

Emergency services at public and university hospitals in France last week began a “general and unlimited” strike, organised by the French Association of Hospital Emergency Doctors. Joined by nurses, administrators, and ambulance drivers, the striking doctors are asking not only for more staff, better working conditions, more beds, and more money but a revamp of France’s entire emergency and out-of-hours care system.

They are also complaining that doctors with private practices do not carry out enough out-of-hours work during evenings, weekends, and holidays, forcing patients to use hospitals instead. They want to see a system introduced whereby most general practitioners with private practice are obliged to do out-of-hours work. Doctors complain that on-call work adds to an already burdensome 55 to 58 hours of work a week, according to the Private Doctors Union. [7]

The public health insurance system covers about 75% of total health expenditures

Half of the outstanding amount is covered by:

  • Patients’ out-of-pocket payments
  • Other half is paid by private health insurance companies

These supplementary health insurance policies can be taken out by individuals or groups.

For example, patients must pay 30% of Social security’s tariff for a physician’s visit and roughly 40% of specialists and 15% of GPs are allowed to charge more than the tariff. Copayments are also high for dental prostheses and eye-ware. This tended to deter the poorest citizens (few of whom had supplementary insurance) from seeking care.

Once varying depending on the fund, disparate reimbursement rates were replaced by uniform rates. The funds are financed by employer and employee contributions, as well as personal income taxes. The latter’s share of the financing has been ever-increasing in order to:

  • compensate for the relative decrease of wage income,
  • limit price distortions on the labor market,
  • and more fairly distribute the system’s financing among citizens.

Most health insurance funds are private entities which are jointly managed by employers’ federations and union federations, under the State’s supervision. The joint labor/management handling has always sown discord within the funds’ boards, as well as between the boards and the State. [8]