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By ATWadmin On January 30th, 2007

largecarte_vitale_pic.jpg"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"


13 Responses to “sante”

  1. Hey Alison – you cracked the READ MORE HERE thingy!

    Very interesting. My problem would be the State taking 20% of MY income to fund healthcare, but maybe a compromise solution lies in what you say. People want a clean responsive and friendly provision of health – our UK model is BUST so let’s look elsewhere.

  2. Yes lol took me a while.

    Thing is i know that is unacceptable for some but i just cannot stand the thought that people are denied what should be basics such as healthcare…

  3. Alison, is the "mutuelle" in addition to the 20% of salary contribution or can it be offset against your mandatory contribution? Would the basic 20% contribution by itself secure you no or only poorer treatment?

  4. hi – yes – and mandatory. you have to pay it. you only benefit from the government only bit if you are under a certain income.

  5. Fascinating. Mind you, I do wonder, I assume that the S.S. payment is separate from income tax. I wonder what income tax rates are like in France, because if they’re similar to here (and the EU seeks harmonisation, so it can’t be that different?) then that’s one heck of a slice out of your salary. -On the other hand, I suppose the market balances itself out based on the overall cost of living?

  6. Excellent article Alison.

    It is so painfully obvious that the 1940s style nationalised centrally controlled inflexible NHS which has remained unchanged in structure since then is so hopelessly out of date in 2007 . Does anyone seriously think if we had a National Food Service with nobody paying cash for their produce , everything centrally allocated and distributed by one state owned supermarket chain and according to fixed annual allocations per person, that we would have anything like the choice and diversity and efficiency that we currently have. So why do so many people insist that health must and can only still be provided in the same old soviet style.

    The French system sounds like an excellent hybrid between balancing health care need regardless of income in tandem with the efficiencies and felxibility of consumer lead service provision. the key to me is the fact that payment is made at the point of treatment which allows the medical providers to carry out the services required when needed without having to think about a pre-fixed budget decided by a bureaucrat many miles away and many months previously.

  7. Cheers and great points about the budget Colm

  8. I think it is at the root of the problem and is a quite simple but crucial handicap in the NHS.

    If you walk into a supermarket and buy 20 loaves of bread, the manager doesn’t have to worry about the bread allocation dissapearing. The money you pay there and then can be used to restock the supply – that is how all efficient goods and services provision works.

    Insurance companies should pay the medical providers the full costs of the treatment at the point of use and the medical providers then have the financial flexibilty to provide the services according to demand. I agree it’s abit more complex than that to organise comprehensively and safely for the whole nation but that starting principle should be applied and recognised as more efficient than the failed mantra of centralised soviet style rigidity.

  9. Ive just taken a glance at the French tax system, seems rather complex compared to ours. For a start, income tax is not deducted at source from your salary, but everyone has to file a tax return. One excellent thing I noticed though, the family is taxed as one unit, meaning that if you’re a married person with 2 kids, but just one person working, your tax is far lower than a single person earning the same salary, as you can divide the salary up as if its been earned by four separate people.

  10. Other interesting points about the French NHS system. All papers given to you, including xrays and diagnosis are your property – i.e. you look after them. You take your own towels into hospital and you pay if you want to watch tv. If you have a chronic heart condition you pay nothing. Yes you pay at point of service but you are repaid 100%. Mutuelle costs are low, even for people over 50. The hospitals are usually pristine clean, there is sometimes a notice on the table beside the bed indicating who was the cleaner of the room. But then the French have an inate pride in everything to do with their country…haven’t yet seen a post office at the back of a sweet shop, their trains look gorgeous and I believe they run on time. OK I hear you cry but the workers ‘downtools’ at the drop of a hat, yes true.They won’t let foreign goods into their country which might undermine their products. They still take a couple of hours for lunch, closed on Mondays, Bank Holidays and all through August. Good luck to them, it is not a perfect world but I hope they don’t change.

  11. Tom – yes its complex and that wealth tax is definitely a hot potato at the moment and being discussed left right and centre.

    Their tax issues aside it still comes down to social security and spend on health care – and we are pathetically low. If you go private it costs you – so one way or other you pay.

    Re our own rubbish taxes – you get taxed if take private health here on top of what many companies pay themselves as they offer private health as part the employment package to quite a few now). You also get taxed here on having company mobile (which most people need!) and a company car, a small bonus gets chopped in half by taxes….there is council tax which goes up and up and up and up, rebanding issues. What about pensions? All comparable? I dunno im very curious though.

    Maggie – some of it will have to change re employment and unions and competitivness but i expect they will keep on top of it. and they wont let a global economy smash their culture to bits.

  12. Aren’t our Social Security payments in the region of twenty percent of gross salary – approx. 10% by the employee and a similar percentage by the employer?

    The downfall of the NHS system is partly due to the ‘free for all’ rule, which is applied without any reference to ability to pay – mustn’t have any sort of means test here, but when it comes to the State Pension scheme, why then, means testing is the mantra of the day… – little wonder that all those Ministers seem so very confused.

  13. When New Labour slithered into power, National Insurance was 10% which paid for your dentistry, now it is 11% and you have to pay extra for dentists services. Is this prudent? Is this value for money?

    In USA, you get what you chose to pay for and some people pay a lot and mostly it works well. But too many people slip though the net.

    In France you pay a lot and get good service in return (due to high quality of French civil service management)

    In UK you pay a lot and get little back due to Gordon Brown squandering your money and managing it so im-prudently.