"Why does socialized medicine seem to work in some places and be a disaster elsewhere? Anyone who reads the British press is assaulted daily with tales of how cancer patients have to wait months for an appointment with an oncologist, or a candidate for a hip or knee replacement has to wait years. In France, such delays can be measured in days or, at most, weeks"
The French healthcare system reigns supreme in my opinion. It is an example of ‘socialised’ healthcare that works. Largely down to a (fairly complex) public private hybrid structure I admit – but – if it works it works. And Im all for looking at issues on ‘merit’.
So here is a little summary of how this seemingly complex but functioning system works so you can make up your own minds….
The fundamental principle of healthcare in France is universal coverage (little wrong in that ). That universal coverage requires an element of personal contribution but in two ways -and it also differs to the British system in that it is NOT ‘free at the point of need’.
Basically 20% of your gross salary in France goes towards paying your ‘Securite Sociale’. And a big chunk of this is funneled into public healthcare. The government provides the ‘floor’ to which every legal resident of France (and the EU) has access under la Couverture Maladie Universelle (universal coverage) and you then decide the ceiling.
Basically to top up the difference between what the state pays and the cost of treatment, you take out an insurance policy to cover the difference – a mutuelle, which gives you your ceiling.
Routine visits to the doctor or to a clinic for x rays, blood tests etc cost around 20 euros. When seeing a doctor or specialist you pay the full bill and are reimbursed at a later date (about a week). Generally speaking, you are covered for 70 per cent of the cost of a visit to a GP or specialist. For more expensive treatment such as hospitalisation the government and your "top up" insurer will pay direct on your behalf. Surgical procedures have a tarif. Say for Major Surgery 95% of that tarif is government subisidsied. Minor Surgery 80% ; Pregancy/Childbirth 95-100%; Prescribed Medicines 35%-65%; X Rays 70%; GP/Specialist Visits 70%.
If your income falls below a certain level (for example, 10, 768€ for a couple) the government covers you, offering an average level of healthcare.
To ensure you get your reimbursement (and are entitled to it) you need to present a Carte Vitale which stores your pic, name address and mutuelle details in a chip, along with your blood group and critical medical history.
Choice and speed are in abundance. You are free to choose your own GP (and there are loads) and see whoever whenever you want. A specialist referral is generally same day or the next day, blood tests and x rays are carried out at clinics to which your doctor refers you the same day or as convenient to you. You are thoroughly and quickly assessed and there are no waiting lists in France either.
My experience of French hospitals is that they are modern, clean and comparable to our private
hopsitals in standards. More generally, Doctors appointments (inlc emergency) are easy, quick and kept on time.
The French system is costly (but I cant see them giving it up). This article here examines some of the choices as they weigh up what and where they cut back. But it is also worth bearing in mind that France spends 10% of their GDP on health – and it gives everyone unlimited care, the US (as a privatised comparison which may not be fair) spends 15% but has 46 million uninsured, and 15 million more underinsured – Medicare falls to the government to write off. The United Kingdom, spends just 6% of GDP on health services in comparison.
Most western nations are looking at how to manage healthcare. The French are looking to curb spending.
But they start from a good premise – that of excellence that must be maintained and excess to be removed. Rather than in the UK where the excess has not justified even excellence. Or in the US where having such a high spend leaves many in a 21st century western nation unable to seek treatment – or (anecdotal…) in my sisters case flailing around with your knee-cap down by your ankle with an ambulance driver refsusing to administer painkillers unless you whip out your insurance.
I would be prepared to pay what it takes to have a system that works and is fair. What i object to here is the excess without a consistent standard for all (as to be fair some benefit from excellent GPs and local hospitals) – and – the utter abuse that leaves our system open to health tourism. Id like to see a health system that underpins all. However ‘Free at the point of need’ is an outdated mantra that does not work for the 21st century. Not when Mr Umbongo rocks up from somewhere in Africa and leaves his terminally ill brother in a wheelchair in an NHS reception needing expensive treatment and then buggers off.
You can read more compare and contrast experiences here:-
A Tale of Two Heart Attacks – UK and France
US and France – A Conservative American convert to ‘Socialised’ Medicine
Anecdotally – My father was taken ill in France not so long ago and the speed and efficiency of diagnosis and care was incredible. And talking to staff at a hospital in France when i was in a hospital there some years back, i was struck by how fiercely proud they are of this system and this is reflected in their work – a healthy culture all round!
"The performance of the system is also judged by the health of its population. France ranks high in terms of overall health and mortality figures. In 1997, female life expectancy at birth (82.3 years) was second only to Japan. Old-age disability is on a marked downward trend, particularly for men, in line with trends in the U.S. and Japan. The same is true for infant mortality, which is just above the very low levels in Scandinavian countries"