Thursday 3 May 2007

Living in a dream world and French healthcare

Came across this post on a HYS forum on (topic is who you think should be next French prez):

The one who guarantees me that health and education will continue to be free for the next five years.

Marie-Estelle, Paris

Hmm. I think Marie-Estelle has misunderstood how her national healthcare system is funded. I, like nearly all other residents of this land, have private complementary health insurance. The policy I have costs 37 euros a month. That's on top of my salary contributions. When I visit the doctor, I pay 21 euros. The state health insurance thing refunds 14 euros, and my private policy refunds 6 euros. So if I didn't have the private insurance, every visit to the doctor would cost me 7 euros. Doesn't sound very "free" to me... [scratches her head]

In fact, the French system is quite clever. Doctors, dentists, ophthalmic specialists and so on are all private. When you visit them, you pay for the consultation. The state system then refunds around 60% (this varies). Everyone has private complementary insurance to top up this refund. So the system is publicly and privately funded. It means you rarely have to wait more than 1 day to see the doc. Good, eh?

Unfortunately this does lead to huge regional discrepancies for some "specialists". Because they are private practitioners, they set up business wherever. Which means all the ophthalmic specialists and gynaecologists go and work in the south where the weather's nice. Here in northern France it's not uncommon to have to wait up to 6 months to see the eye doctor or the dentist! That's one of the downsides.

The other major downside is prescription drugs. There has been a big push to encourage pharmacists to give people generic medicines where they exist, which are much cheaper than the brand drugs. But the patient can still refuse the generic and insist on the "name" version. I advocate that this freedom of choice should remain, but all drugs be refunded on the basis of the cost of the generic version, so when patients want the brand drug they can pay for the difference themselves. Fair, no? Also, chemists don't prepare prescriptions at all, they just dole out pre-packaged blister packs of drugs. If your prescription is for 1 tablet twice daily for 10 days, and the medicine is sold in packs of 15, then you get two packs (ten more tablets than you need). Wasteful, no?

Big hospitals are public, where the staff are paid by the state. You still have to pay for any care you receive here, even if it's emergency care. Usually your health insurance combined with the state insurance covers all the costs and you have nothing to pay, and there's no horror scenario where they refuse to treat you if you don't have insurance! Then there's a myriad of private clinics. In public hospitals the standard of care is probably comparable to most other big European countries. Private clinics are a different matter, some are very good and highly regarded, others are far too concerned with the finances and patient care suffers.

Still, the NHS could benefit from the introduction of minimal private "top up" insurance, and asking for a contribution (could be as little as five or ten pounds) when people visit the doctor, let's say. Before I lived in France I always reacted in horror to the idea of bringing private funding into the NHS, but I do now think it should be seriously examined.

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