France is consistently rated number one in health care from the World Health Organization to OECD (Organization for Economic Cooperation and Development).  So we will continue with our project of outlining how other countries approach health care. 

In the months ahead, we will be hearing a lot about socialized medicine and how other countries pay more in taxes for “government run health care.” So, we will look at these systems and post outlines that cover:  management; doctors and hospitals; role of the employer; role of the individual; role of the government; who decides benefits and services; universal coverage (cover everyone); financing and health care insurance premiums.

What seems to be the case in most of these economically developed nations is that they cover everyone; the doctors have private practices; hospitals are both public and private; the government steps in for the poor; employers participate and pay and can add additional coverage for their employees.

In France, health care is funded by workers’ salaries, indirect tax on alcohol and tobacco and direct contribution of all revenue proportional to their income (including retirement pensions and capital revenues).   Individuals and employers often have private insurance to cover the portion the government does not cover, typically 20% of the charges. 

What seems to be the critical difference is that these nations have one common set of benefits that everyone gets no matter if they are employed or their employer size.  Because everyone is covered, the other nations are spared the “eligibility, authorization and referral” paper nightmare we suffer from here in the United States. They have one standard claim form. Everyone knows what is covered.   This would make a huge difference to the practice of American medicine, where physicians’ overhead accounts for over 50% of their income.

Read our factsheet on the French Health Care System

In France, they also treated malpractice claims as we do here in the US. However, they recently abandoned that approach and now instead have moved to an out-of-court , no fault system where the patient brings claims to their region’s government appointed review board, which decides the case and the compensation. Compensation comes from a national compensation fund that gets its money from insurance premiums from doctors and hospitals (Learn more about malpractice around the world).

So, please read on. 

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.