A friend forwarded this column to us about the French Health Care System by Mary Cline.  We have three more installments coming from Anne Kinzel on French health care, so please stay tuned.  After that I will be doing a series on how other countries handle health care and its cost. 

I noticed Cline’s doctor to patient ratio is different from Anne’s.  We will double check the data and report back.  One of the questions I have is who pays for medical education in these other countries and if there are significant differences in income for primary care and specialty care providers. 

Please follow this link to read Cline's article

Cheers and more later.  Kathleen

Don't tell the French they have socialized medicine!

By Guest Blogger Anne Kinzel

In my last post I noted the French health care system is based on choice.  It’s hard to make that assertion and not face serious skepticism.  After all, the French have to pay huge taxes whether they want health insurance or not.  What kind of choice is that?  The French can’t get out of paying even if they are opposed to receiving health care on moral or religious grounds.  It’s just another system killing the individual through taxes and mandates.

Before we look at how the French have created a tapestry weaving choice and mandates, I want to present a little scenario to you about our own country.  It’s about the question, “When is a mandate a mandate?” Be careful, don’t try this as home!

Bob, a clever guy, recently read over his payroll stub.  Amazed at how much of his hard-earned compensation was taken out for his health insurance, he did a little research.  Then, he went over to payroll.  He told the insurance specialist, “Look, I investigated these new health savings accounts and I think they are good deal for me.  Here is what I need you to do.  Please fill out this form – It takes the $875 you pay to our insurer for my family coverage each month and sends part of that money to ConsumerCo.  $450 will pay for my new family plan.  $300 is going to go straight to the health savings account that goes along with new plan, and $125 can go to my retirement account as extra contribution.  This works out really well.  My Aunt Mabel left me a nice a chunk of change and I put that into my health account to cover that big deductible.  In our family everyone lives forever and never seems to get sick.  So with this deal, I can’t believe how much we’re going to benefit.”

When Bob got home that night, here is what he said to his wife, “You won’t believe what they said down at payroll! – They said ‘NO WAY!  You’re either in the plan or your outta the plan.  We are not sending any money anywhere just because you say so.  If you want out, we’ll reimburse you $250 a month.’  I said, ‘You gotta be kidding, that’s my money, I earned it, the whole $875!  So honey, I guess we’re just not going to be able to go with ConsumerCo; they’re saying it’s just not our choice.’”

Choice.  What a loaded word when it comes to health care! But what about choice in the French health care system.  There are some realities that have to be understood to ‘get choice,’ French style.

First, the French have the right to choose among all types of healthcare providers, irrespective of income.  They can choose to receive care from public, private, or teaching hospitals and they can pick from a large number of primary and specialist physicians.

In France, the ratio of doctors to residents is 3 to1000. By comparison, in the U.S. it’s 3 to 2700, in Great Britain 3 to 1800, and in Germany 3 to 3400.  The number of French docs is not all that surprising.  The French look down on the British system and those long lines they’ve heard about, dismissing the whole thing as "socialized medicine."  That one sounds familiar!

The French don’t think docs should be employed by the government unless the docs want to work in the public/teaching hospital environment.  So the choice is entirely left to the individual practitioner, just like the choice docs have of participating in La Sécurité Sociale—one almost all physicians make.

All this is paid for by two insurance systems, one public, la Sécurité Sociale, which includes the health care and retirement systems, and a large supplemental health insurance system.  Additionally, there is an intricate system of co-payments, based on diagnosis and income.

La Sécurité Sociale is funded by levies on worker salaries, by taxes on alcohol and tobacco, and by additional taxes paid on income, which includes retirement income as well as capital revenues.  Supplemental insurance, which covers about 90 percent of population, is often provided as a benefit by employers.  According to the French way of defining the things, only the poorest citizens enjoy taxpayer financed “free universal healthcare.”  (See “The French Health Care System,” Embassy of France)

None of this sounds extraordinary; though the distinction between primary and supplemental insurance is something Americans are not familiar with.  And our Medicaid system is nowhere near “universal” in its reach!  Where things start to sound seriously different is the 100 percent reimbursement for the care received by anyone suffering from long-term illness.  What a concept, if you are really sick, you get the most coverage.
Chew on that for a while and I will get back to you soon to talk more about French docs, supplemental insurance, and that incredible idea of cost going down as care needs go up.

For those of you who like a little visual information, check out a little CNN video clip on French health care here.

Welcome to Guest Blogger, Anne Kinzel, JD.   Anne, a CodeBlueNow! Honorary Board Member, is currently employed at large, midwestern public university.  Anne is well-versed in issues of health policy and health disparities resulting from social inequities; she gained this insight working as the Iowa Department of Public Health’s State Planning Grant Project Director.  A Franco-American citizen, Anne writes today about what we can learn from France’s health care system.

It’s a big world out there and Americans are notorious for being oblivious to geography. Nowhere is our ignorance hurting us more than in our favorite topic of health care reform.
 
Bring up universal coverage in the U.S. and more often than not someone will mention Canada, long lines, and those hordes of Canadians crossing the border in search of available and affordable health care. Those with a slightly broader world view usually bring up the failure of socialized medicine in Great Britain. I am not going to debate the veracity of these claims. True or not, I am tired of them, really tired.
 
So, if you are like me – and are bored with Canada and the U.K. – it’s time to take a trip to France and look at health care, French style. Like all things Gallic, France’s system is elegant and pragmatic, admittedly imperfect, and more than a little Cartesian in approach.
 
What can we learn from the French when it comes to health care and health care reform? It turns out a lot, and maybe the most important lesson we can learn is that it is absolutely possible to deliver good quality health care, to an entire population, at an acceptable cost.
 
By now, you either think I am high on goose liver pâté, an idiot, or some kind of weird optimist. But here’s the deal – The French are as aware as we are that there is no perfect system and that in health care there are no days without challenges either at the individual or societal level.
 
And yet, the prickly French have managed to devise a system that was rated the best in the world by the World Health Organization in 2001, because of its coverage universality, its recognition and respect for patient and provider autonomy, its ability to promote longevity and good health. In that same year, our American system achieved a ranking of 38th, and I don’t know anybody who thinks we have improved much since then.
 
Here are just some of the things that I think are important about French style health care that I will be addressing:

• Provider choice is sacrosanct. The French system is based on choice.
• Quality costs and it pays. The French system is not cheap ($3,048 per capita vs. $6,711 in the US (KFF Snapshots: Health Care Costs. Health Care Spending in the United States and OECD Countries, January 2007.)
• There is no socialized health care in France. There is a national health insurance, la Securité Sociale, or as the French call it, la Sécu. It coexists with a large private health care system.
• French doctors are a long ways from the poor house. But their pill hill residences are far more modest than those of their American counterparts.

These are just some of the things we will explore. Remember, it’s never too late to learn something new. I hope you will join me as I post over the course of the next week. Why not say, “Zut, alors! Maybe the French are on to something. It’s a big health care world out there and I want to know more about it.”