Health Care: France

Because the blogs are populated by that rarest of above-ground breeds, the policy nerd, there's been a lot of talk lately about the health care structures of various other countries, how they stack up with ours, and why we lose. What there hasn't been is much information on how these other countries actually work, save for "better" and with "more government". Since I have a very peculiar idea of what "fun" is, I'm going to try and correct that. Each day this week I'll be writing a bare bones guide to another country's health system so when you're discussing say, France, you know how it works rather than that it simply works better than ours does. Speaking of France, I'm going to start with them, because they've gotten the most attention recently. Tomorrow I'll do England, the next day Germany, Thursday will be Australia, and Friday we'll do Canada. It'll be fun, I don't promise. Alright then, off we go:

France:

Da' basics: France has a basic system of public health insurance that, as of January 2000, covers everybody in the nation. Before then, portions of the population lacked insurance. The reimbursement rates are wholly uniform, despite the fact that there are actually three health care funds, a main one covering most workers, and then one for the self-employed and one for agricultural workers.

As that hints, the health care is occupationally based. It's paid for through employer and employee contributions (much like Social Security), in addition to personal income taxes. The latter have been increasing in recent years.

The funds are private entities under the joint control of employers and unions, which are in turn supervised by the state. As might be expected, that doesn't work particularly smoothly, and there's a constant battle for authority and control. Creative tension, one might kindly call it. The funds are mandatory, no one may opt-out, and they're not allowed to compete with each other nor micromanage care.

The public system covers around 75% of total costs. Half of the rest is paid out-of-pocket and the remaining is made up by supplementary insurance companies. About 85% of the French have some form of private insurance, which pays for the various procedures and equipment the public insurance doesn't wholly cover. This of course led to inequality, so in January 2000, a means-tested public supplementary insurance program came online in order to ensure that the poor got top care.

France is the only country where access to care is unlimited. Patients can see as many doctors as they damn well please. They don't need referrals to see specialists, and there's basically no gatekeepers at all (this is going to change, recent reforms mandate a principal doctor -- a gatekeeper -- if you want full reimbursement).

The health care system is mainly under state control. The state plans out hospitals, the allocation of specialized equipment, etc. Some of this is done at the regional level, a trend which seems to be increasing. The hospitals offer about 8.4 beds per 1,000 people (America, btw, offers 3.6. Ouch.) The public sector provides 65% of the beds, private hospitals -- which operate on a fee-for-service basis -- make up the rest, and primarily concentrate on surgeries. French citizens choose which one to go to and get the same reimbursement at either. How's that for choice? Not good enough? The French also get to choose their physicians, their physicians get to choose where they practice, and there's patient-client confidentiality.

Problems: France still has class and geographical disparities in their health care outcomes. They're not nearly what ours are, but they exist nonetheless. In addition, various hospitals offer varying levels of care, health costs are rising (again, not as much as here, but still significantly), and physicians often don't feel they're paid enough for their services, leading to a number of recent strikes. As it is, French physicians only make US $55,000, about 1/3rd what their American counterparts pull in.

Yes, but are we better? Right, you say, that's all very not interesting. But how do we stack up with France? Better? Worse?

Yeah, the second one. France's health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.

So France spends less, gets more, and does so through a public-private hybrid that's heavily, heavily public. Socialized medicine sure is scary.

Sources:
A Conservative Convert to Socialized Medicine by David Burgess. Link.
OECD frequently requested data. Link.
The Health Care System Under French National Insurance: Lessons for Health Reform in the United States by Victor Godwin. Link.
The French Health Care System. Link.
French Health Care Reform: A Step in the Right Direction by Claudia Broyer. Can't find the link.

Update: Big ups to the new readers finding this post. We'll be doing different countries all week, so y'all come back now, y'hear?