The French Healthcare System

Bill BerlinOctober 19th, 2013

Ferris State University

The Basics

• All legal residents have health insurance, provided by “couverture maladie universelle” or universal health coverage. • Social security covers 80% of the

population. Two other funds are available for the self-employed and agricultural workers.

The Basics cont’d

• Health insurance is mandatory, no one is exempt.• 90% of French residents also purchase supplemental insurance.• Reimbursement is regulated by the state.• Financing comes from employers, employee contributions and

personal income taxes.

Hospitals

• Public hospitals account for the majority of hospital beds. Also responsible for ongoing care, training and education• Private hospitals are profit driven. Generally focus more on surgical

procedures, depend on fee-for-service as a means for funding.

Coordinated Care

• Every patient has a general practitioner registered with the state as that patient’s primary healthcare provider. • The general practitioner is responsible for making referrals to

specialists (an orthopedist for example).• Exceptions are made for ophthalmologists, gynecologists and dentists.

A patient does not need a referral from their general practitioner to be covered by the state.

Reimbursement

Again, reimbursement is covered by the state. On average, patients are reimbursed:

70% for an office visit.80-95% for surgery70% for x-rays, dental care and home health care. 95-100% of costs associated with pregnancy and childbirth15-65% for medications, depending on type.

Reimbursement cont’d

• Residents making below a certain income are eligible to receive 100% reimbursement of healthcare expenditures.

• Pictured at right is the carte vitale, which patients must present when receiving health services. This card forwards all healthcare encounters to the patient’s health insurance fund.

Physicians

• There are 3.3 active physicians per 1,000 population.• The majority of physicians

specialize in general practice. • Medical school is paid for by the

state. • Because of a strict fee schedule,

French physicians tend to make much less than their global counterparts (about $55,000 US).

Global Comparision

• In 2000, the World Health Organization ranked France the number one healthcare system in the world. • Although some of the criteria used

was highly criticized, data such as infant mortality and patient satisfaction is impressive. • Unlike other countries with universal

healthcare, citizens do not voice complaints about healthcare being “rationed”.

The Pros

• Healthcare is easily accessible to all residents

• Testing, such as labs or radiology, are quickly obtainable.

• Patients have the freedom to choose own physicians, and may select public or private hospitals (for a slightly greater out of pocket fee).

• More government oversight on healthcare.

• France has a higher population health status in comparison to the rest of the world.

The Cons

• Healthcare accounts for 11.2% of France’s GDP.• 20% of employees’ pay deducted

for social security fund.• Because of the French “lassiez-

fare” sentiment, there can be a lack of consistent quality care. • Physicians are poorly paid in

comparison to other countries, leading to tension and strikes.

French vs US Healthcare

French• Healthcare accounts for 11.2%

of GDP.• National Health Insurance

coverage increases for severe and chronic illnesses. • Private hospitals account for

only 36% of hospital beds.

US• Healthcare accounts for 17.9% of

GDP.• Out of pocket expenses go up as

a Medicare patient’s healthcare costs increase.• Private hospitals account for

more than 80% of hospital beds.

French vs US Healthcare cont’d

French• Non-physician personnel per

hospital bed- 1.9.• Healthcare associated costs per

capita- $4,952.• Deaths among people less than

75 years old from heart attacks, strokes, diabetes and bacterial infections- 55 per 100,000 people.

US• Non-physician personnel per

hospital bed- 5.7. • Healthcare associated costs per

capita- $8,608• Deaths among people less than

75 years old from heart attacks, strokes, diabetes and bacterial infections- 96 per 100,000

Implications for US Healthcare Reform

• US spends almost double per capita on healthcare than France, but has much poorer health outcomes.• France has contained costs much better than the US. Although France

spends more on healthcare than many countries, their use of health care services is also much greater. • The French healthcare system shows it possible to have universal

healthcare without a single-payer system.

Quiz

1. What percentage of the population has health insurance in France?2. Name one specialty a patient does not need a referral from their

general practitioner to see.3. What is the average salary of a French physician? 4. What is the card called a patient presents at every healthcare

encounter?5. How much does France spend on healthcare per capita?6. What is one problem a French citizen may have with the healthcare

system?

Bibliography

• http://data.worldbank.org/indicator/SH.XPD.PCAP• http://www.medicalnewstoday.com/articles/9994.php• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/