We are starting a series on our blog on what other countries’ health care systems look like.   Significant misinformation exists on other health systems, so we thought we would start by taking a look at a few key countries that operate most like the US.  Anne Kinzel, JD, has been writing about France.  She has one more post on that, but we wanted to start with some other countries as well.  Basically, covering everyone is not rocket science.  It does, however, take political courage and public will.

Before we take a look at these systems, here is what many of them have that we do not:

• One national agency that negotiates rates and defines services
• One standard set of services for everyone
• Employer and individual may add more benefits
• Administrative simplicity
• Standards
• Majority of physicians are primary care
• Private, nonprofit insurance companies
• Mediation prior to litigation for malpractice

The simple act of having one basic set of services for everyone eliminates the vast complexity that drowns our health care system.  If we had one basic set of services that everyone was eligible, we would eliminate probably a third of the cost of our health care system. 

We will look at these issues in greater depth as we move forward.  We invite your comments and insights. 

Cheers and more later.  Kathleen

From Guest Blogger Anne Kinzel

Earlier in this series I commented that French docs are a long way from the poor house. Today we will talk about what that really means. Next time we will also look into how the French reduce the financial burden of serious illness on individuals and families.

One way of looking at physician incomes is to understand them in relation to national salaries. The hard facts are not that favorable to French doctors. According to Paul Dutton, an American academic who is a leading expert on the French health care system, “the average French physician” earns more than twice the French wage. That is not bad until you find out that the average U.S. doc makes more than five times the average U.S. wage. Yes, that’s right, about 500% more than the average Joe and Jane. But there is a lot more to this story then cold cash.

• Cheap medical schools. French physicians graduate from medical schools never having paid a dime in tuition. They do pay fees of no more than U.S. $500 to a $1000 per year. Ouch – not really!

That’s right – no loans to pay off med school tuition. That is definitely worth something.

In contrast, the American Medical Student Association estimates 86 percent of U.S. medical school graduates enter their residencies carrying debt.  In 2006, median debt was $115,000 for public medical college graduates and over $150,000 for private school graduates! For French docs it has to be a lot easier to buy that first house!

• Not much time in court. While the French have a well-deserved reputation for being prickly, they don’t sue their doctors much at all.

It’s not that they can’t find their way to the courthouse. Instead, cases with bad outcomes attributed to less then stellar physician care are referred to investigative commissions.

There, a magistrate and a panel of experts reviews each case and decides what compensation, if any, is due the patient. Before anybody is compensated, a patient has to prove: 1) Harm occurred as a direct cause of the medical treatment received; 2) the harm was serious enough to have a detrimental effect on the patient’s health; and 3) the patient has to show that he or she suffered at least a 25% reduction in physical or mental capacity as a direct result of the harm suffered. Patients can refuse to accept a settlement from the commission and test their cases in court, but few do.

It’s a pretty drama-free system, meaning that malpractice premiums are not the large cost of a doing business as they are in the U.S. Not being so afraid of patients may not be measurable on the bottom line, but its got to be worth something!

Add to this, offices without a billing staff, not having to deal with multiple insurers, and the five weeks of time off a year, and it’s starting to look like French docs don’t have it so bad!

The bottom line: One of the reasons that health care in France is less expensive than in the U.S. is because doctors earn less money. Would American doctors accept lower salaries? Probably not, but just maybe American doctors would not need so much compensation if they didn’t graduate with huge debts! This could be a reform worth looking into!

Coming up next: Serious illnesses and their financial impact on families.