France: Number 1 Healthcare System in the World

So, turns out there are tons of information available about the French healthcare system. And, of course, all systems are complex with many different facets.  In this blog post, I’m going to point out a few things I found most interesting.  At the end are all the resources you can read for further understanding and more in depth analysis.

The World Health Organization ranks France #1 in healthcare systems in the world. As far as spending is concerned, France spends the 10th most on healthcare per capita ($4,118) in the world and 3rd by GDP (11.6%). Life expectancy is 82.2 years. All citizens have access to health care regardless of income or ability to pay. 95% of French citizens purchase optional private insurance that supplements their national health coverage.

National coverage is granted either through employment, self-employment, or granted to students, those retired or those unemployed that were previously employed. Costs for care are shared through copayments, co-insurance or balance billing. The optional private insurance usually covers the copayments and out of pocket expenses (typically the 30% that the National plan does not cover) . Low income individuals have their private supplemental insurance covered by the government, get free dental and free vision. Having private insurance isn’t a matter of prestige; in other words, it isn’t’ a ticket to faster care or private doctors.

There are NO deductibles (Holy Cow – we’d LOVE that here in the U.S wouldn’t we!). Doctor visits are paid upfront, but then reimbursed less the copay. Pharmacies are paid directly for the prescriptions less the copay you pay when you pick it up

The state sets fixed prices for services  (and drugs) , and if a physician you choose charges more above that state fixed price the patient is responsible for the difference (known as Balanced Billing) . Balance billing may be covered by your private supplemental insurance, depending on the plan you choose. So, when something, like diabetes, is covered up to 100% it refers to 100% of the fixed state price. It doesn’t apply to any surcharges that a physician may charge above that.

Co-payment rates:

  • Inpatient 20%
  • Doc visits 30%
  • Dental 30%
  • Highly effective drugs (like insulin) have NO co-payments
  • All other drugs 40-60% based on therapeutic value

In addition, there are a list of chronic conditions that the National Health Plan covers 100% of the state fixed price, with no out of pocket costs to the patient (excluding any surcharges above state fixed price, as mentioned above) . That list includes the following chronic conditions:

  • Rheumatoid arthritis
  • Asthma
  • Type 1 and type 2 diabetes
  • Parkinsons
  • Alzheimers
  • Hepititis B & C
  • Liver Cirrhosis
  • Peripheral Arterial disease
  • Parapalegia
  • Strokes
  • Epilepsy
  • Cancer

In France General Practitioners (GP’s) can enter into a contractual agreement with a guaranteed income of EUR 6900/month  if they set up a practice in a regions with insufficient number of physicians. Doctors that elect to work full time in medical centers receive a  guaranteed salary income of EUR 50,000 ($53K US) .  (Average median salary in France in 2016 was a little more than 26,000 EUR or $27,600 U.S)

Ultimately, the French system sounds like Medicare for all; prices for reimbursement set by the government for treatments, procedures, doc visits and drugs .  And while private insurance helps patients cover out of pocket costs, the playing field is kept level because Private insurance is NOT a guarantee of quicker or preferential treatment.

Of course, health care systems are very complex; too complex for me to cover everything in one blog post. France is not without problems, as they have been operating at a defecit. However, reforms have been enacted to reduce costs like increasing the amount of copayments, particularly in non-generic drugs,  and working to eliminate things like double testing and making things more efficient.   Generic drugs are pushed and encouraged, with patients being required to pay out of pocket for brand name drugs when generic is available. The reasons for the deficit are similar to the issues the U.S faces; an aging population and higher prevalence of chronic conditions like diabetes.   But,  France has managed to reduce their deficit significantly and they did so without moving to a competition based market, but rather making some of the changes I mentioned. I’m not going to go into that here, but I did want to mention that it isn’t perfect. Nothing ever is.

Here are some of the questions I have that, with a little more research, I hope to find the answers to and add to this site. I do know someone living in France (an ex pat) and I will reach out and see if she can provide me some insight as an American living in France.

  • What is the average cost of private health insurance in France?
  • How many doctors charge a surcharge above the fixed state price, and what, on average, is that surcharge?
  • What are insulin pumps and CGM’s considered in France, in other words, are they fully covered or are they considered brand that would be covered to a certain extent? (I did find a document on line about standard practice guidelines regarding chronic conditions that, when translated, listed injection equipment like pumps as standard for treatment of Type 1 diabetes and those with Type 2 that require insulin. So, it appears that in France Pump Therapy is a standard of care covered.)
  • What is the cost to French citizens for Humolog insulin compared to the U.S.?
  • How much is an insulin pump in France?
  • How much is a CGM in France?

And, while I am focusing on diabetes, other chronic conditions are most likely treated in a similar fashion. I’d be curious to see what other drugs that we pay so much for here in the U.S, costs in France.

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