What is health care like in France?


Here it comes. How dare I suggest the US could learn anything from France? By most assessments France provides the best health care in the world, with excellent life expectancy, low rates of health-care amenable disease, and again, despite providing excellent universal care, they spend less per capita than the US. Using about 10.7% of GDP and about 2000USD less per capita than the US they are providing the best health care in the world. To top it off, France’s system isn’t even socialized. That’s right. It’s yet another system that is a mixture of public and private funding that, if anything, provides the greatest level of physician and patient autonomy in making health care decisions. It is not, I repeat, not a single payer system. Doctors are largely self-employed, there is no big government authority telling doctors and patients what to do, just a progressive tax structure and requirements to pay into the system that fully subsidizes a functional healthcare system.

Start with the Wikipedia entry, if you can stand to read it try the WHO document on the structure of the French system, or various articles which all seem to agree the French system rocks. The few criticisms stem from it’s relative cost compared to the other European systems and perhaps overutilization by citizens. But no one asserts that it provides poor care, that it rations care, that it limits doctor or patient autonomy, or has poor resources.

As with most health care systems, the more you read about it the more you see how the system reflects the values of the country. But these should be universal values.

Starting with free medical education, virtually no need for excessive administrative staff to deal with paper, full physician autonomy and a non-existent medical tort system, France sounds like an ideal place to practice medicine, but you do get paid less. The French system is universal, has public and private elements, and doctors enjoy great autonomy without interference from a centralized health system looking over their shoulders. The poor are covered, but those who work all have to pay into the system proportionate with income. Further, it’s bolstered by a separate schedule of progressive taxes so much of it is subsidized by the wealthier citizens. The public system pays the majority of medical expenses but the overwhelming majority of French citizens opt for private coverage to make up the difference. If one can not afford the private coverage and one gets sick, the coverage expands to 100% of your costs, so debilitating illness and loss of income don’t mean people go bankrupt to pay their medical bills. The main criticism seems to come from those that aren’t indigent enough to qualify for additional benefit, but not wealthy enough to buy into additional health insurance to cover the copayments, may fall into a limbo, but seems to be a small minority of the population.

It’s by far the most egalitarian system out there, so it’s not surprising that it provides the best health according to WHO rankings, outcomes like life-expectancy, infant mortality, mortality from health care amenable disease, surveys of patient satisfaction . Unlike the British NHS and the Canadian health service, universality is balanced with significant patient autonomy, the system allows one to pay for more coverage if desired, and one may chose one’s own physicians and hospitals. Finally, there is no rationing, no wait times, no limits on care. People get the care they need, and it’s not restricted by government guidelines but rather solely by physician recommendation. If a doctor prescribes a treatment, it’s paid for.

This brings us to a question about the US system. Why is it so expensive? How is it that we still end up spending so much, when a system like the French one, universally accepted as superior in outcomes, service, and quality, manages to spend so little?