HEALTHCARE IN FRANCE: IS THIS THE WORLD’S BEST HEALTHCARE SYSTEM?

It is probably not a secret to anyone that on various health measures such as life expectancy and infant mortality, the healthcare system in France ranks considerably higher than the United States. In fact, the World Health Organization concluded that France has the world’s number one healthcare system. Interestingly, France has more doctors per capita than the U.S. and more hospital beds. You should note that the French are not shy about visiting the doctor, making about eight visits per year compared to five in the U.S. Moreover, they take more pills and receive more injections than Americans. In a nutshell, the French appear to get high-quality healthcare while paying less than we do.

Healthcare in France is a system of private doctors who treat patients that buy health insurance from a government health plan or private insurers. As is here, private doctors charge patients on a fee-for-service basis. Health insurance is obtained through the job, where employer and employee share the cost with premiums deducted from the worker’s paycheck. Moreover, there are co-pays, though the insurance plan reimburses most in France.

Most importantly, health insurance funds in France (caisses d’assurance maladie or sickness funds) are nonprofit! As opposed to the U.S., the chief responsibility of insurance companies in France is not to provide a return to investors but instead to pay for people’s healthcare. In France, patients cannot be turned down for pre-existing conditions. It is the same in the U.S. since the institution of the Affordable Care Act. However, French insurance companies cannot terminate services even if an insured loses a job. If that happens, the same insurance plan is continued, with the government paying the employer’s share of the premium. In addition, there are no deductibles, and it is illegal for insurance companies to delay payment (doctors are usually paid within a week). Administrative expenses, which in the U.S. for private insurance companies runs approximately 20%, is less than 5% in France. (Interestingly, administrative costs for Medicare in the U.S. are less than 3%!). This low cost is understandable given that the French insurance companies do not spend money on marketing, viewing or denying claims, or paying dividends to stockholders.

Aside from pediatricians, which are in short supply, waiting times are about the same as in the U.S. The French may go to any doctor in the country, including specialists. There is currently no gatekeeper system; however, in 1997, the government did try to establish such a system. The rebellion was furious. Demonstrations by patients and doctors blocked the streets of Paris, and eventually, the government conceded.

Everyone must belong to a health insurance fund in France: it is illegal to opt out, no matter how healthy you think you are. There are three main funds—one for salaried workers, one for farmworkers, and one for professionals and self-employed. There are supplemental policies that can be purchased from nonprofit or for-profit companies because these policies are incredibly inexpensive. And because they are so economical, approximately 90% of workers buy them.

One of the essential features of the French system is the Carte Vitale. Initially introduced in 1998, it is a green plastic card that is French medicine’s primary administrative tool. All French medical facilities, including doctors’ offices, are equipped with a reader for the card. All citizens, 16 and older, must have one, as it carries all the patient’s insurance details. The Carte Vitale allows direct reimbursement from the insurance fund with no additional forms. Introduced in 2008, the Carte Vitale 2 is equipped with a memory chip and possesses a copy of the patient’s medical record. Essentially, the French will carry their EMR (electronic health record) with them from doctor to doctor, from lab to lab, and hospital to hospital. The card currently allows direct reimbursement from the insurance fund without sending additional forms.

On the other hand, doctors make about a third of what their counterparts make in the U.S. However, no French doctor pays a penny to attend college or medical school so that none will graduate with the debt American doctors face (~$100,000). Similarly, malpractice insurance is a small fraction of what it is in the U.S. 

In conclusion, France is a multipayer healthcare system with multiple sickness funds and several supplemental plans. In practice, France acts like a single-payor system because the National Health Ministry dictates what providers can charge for most treatments and what prices are paid for prescriptions. Unlike the U.S., the French government negotiates prices with doctors, hospitals, and drug companies for the sickness funds. In many instances, patients are informed upfront with visible waiting room signs, how much they will pay for each visit or procedure, and how much they will get reimbursed by insurance. According to the World Bank, in 2014, France spent approximately $4959 per capita compared to $9403 for the U.S. Ultimately, the French system uses private doctors, hospitals, and insurance companies. Costs are controlled by strict and uniform price control as well as nonprofit insurance plans.    

Reference: T. R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care