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Is French Health System a Model for U.S.?

Is French Health System a Model for U.S.?

The Dallas Morning News

May 18, 2009

The Huas pay their doctors at the time of service for house calls and office visits, but their insurance deposits reimbursements into their checking account in a matter of days. All of their medical care is covered by two health insurance policies that together cost them 77 euros a month, or about $102. The Huas used to spend another $100 a month for a better supplemental insurance policy than the one offered by Mr. Hua’s employer, but they dropped that policy after he switched to a job with better benefits.

Identity cards

Insurers and providers use a common electronic billing system tied to identity cards that carry a microchip containing reimbursement information. Health economist Gerard de Pouvourville said the system’s efficiency reduces overhead to less than 4 percent of the plan’s cost.

For several years, a team of researchers at Harvard Medical School has argued that up to a third of the U.S. medical bill goes toward overhead for insurance companies, marketing, hospital and physician billing departments, pharmaceutical advertising and the like.

(Insurance firms and others dispute that overhead estimate. Comparable estimates for France are hard to come by. The Paris-based Organization for Economic Cooperation and Development collects health care overhead estimates from governments showing France at 6.9 percent, and the U.S. at 7.5 percent. OECD health data expert Gaetan Lafortune says both estimates are too low.)

In France, the national insurance plan’s trustees negotiate a fee schedule with physicians’ unions and hospitals. An office visit with a general practitioner costs 23 euros, or about $30. Patients are expected to pay one euro of that cost out of their own pockets. Insurance reimburses them for the rest.

Most doctors stay within the plan, but about 30 percent have opted out and are free to charge what they like. (Leaving the plan cuts them out of a government-funded pension.)

Employers contribute 12.8 percent of employee compensation for national health insurance. Workers contribute 0.75 percent. Chronic deficits have forced the government to add large amounts of tax revenues to health insurance financing, including a 5.25 percent income tax surcharge.

Tabuteau, head of the Department of Health Policy and Management at the Institute of Political Studies in Paris, warns that this is an inadequate model that will force the French government to either raise employee contributions or limit national health insurance to the 10 million people with chronic illnesses.

Money still talks

Elizabeth Dutertre has had three surgeries to correct double vision. The first was at the H"tel-Dieu, a public hospital across the street from Notre Dame Cathedral, where an unexpected opening in her surgeon’s schedule let her get an operation within two months of diagnosis.

“At the end of it, I had nothing to pay,” she said.

The second time, she was told it would take two years before her surgeon could schedule her at a public hospital. She went instead to a private hospital, where her surgeon operated within three weeks. At discharge, she got a bill for 350 euros, or about $465.

“They immediately wanted a check — no Visa card, no American Express,” she said. “If you can afford the out-of-pocket expense, you get quicker, better care.”

Dr. Marie-Laure Alby, a general practitioner in Paris who shares a practice with three other doctors, said government-set fees don’t provide enough money to cover expenses. The practice where she works offers patients care six days a week, 12 hours a day, including house calls. The four doctors share the cost of two secretaries and one nurse.

General practitioners in France earned about $84,000 in 2004, or $62,000 less than their American counterparts, according to the latest estimates collected by the OECD.


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