Everything You Ever Wanted to Know about National Health Plans ….and maybe more - France

France

"In the movie Sicko, Moore lumps France in with the socialized systems of Britain, Canada, and Cuba. In fact, the French system is similar enough to the U.S. model that reforms based on France's experience might work in America. That's not to say the French have solved all health-care riddles. Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization (HMO) tactics to rein in costs.

Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents. And France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation."

Subscription to the general French social security system (except in some specific cases) gives rights only to the basic health insurance coverage which reimburses usually only part of medical expenses.

Regardless on whether you are insured in France or in your home country, you are generally required to pay medical expenses as they occur, e.g. when visiting a doctor, buying prescribed medicines and for medical tests. Then you can ask to be reimbursed by your health insurer. A general doctor may charge from €20-25 for a consultation, a specialist €25-30. Fees will be higher at night or the weekend - a home visit will also cost more.

"Types of payment vary: doctors usually prefer payment by check and some organisations might not accept cash. Only in some cases - such as some hospitalisations or if you are covered by specific heath coverage - you may be exempt from advance payment.

If you are subscribed to the French social security, you need to send a completed form (feuille de soins) to your CPAM (Caisse Primaire d'Assurance Maladie). Reimbursement takes usually 2-3 weeks and you can check on-line on www.ameli.fr (you should receive access information in the documentation provided by CPAM).

If you have a Carte Vital and the doctor (or a healthcare organization) is linked to the social security system, it is possible you may only pay the non-reimbursable part instead of having to claim it back afterwards. "For some medical costs (e.g. dental or orthopaedic prostheses), you must get prior approval from your CPAM to ensure subsequent reimbursement.

This is why most people - nearly 85% of the population in France - choose to take a complementary private insurance (mutuelle, assurance complémentaire). This additional coverage covers partly or completely the percentage of medical costs not paid for by the general social security system. Some employers pay for some or all of an employee's supplementary coverage. In our directory, you find a list of some mutual heath insurance organizations.

French health care is badly run

BBC Article - a report written by the High Council for the Future of Health Insurance

Growing deficit

The report says an ageing population and the high cost of advanced treatments will help push health spending past 9% of gross domestic product - one of the highest levels in the world.

France must make big changes to its health system in order to cut waste and increase efficiency, a government-commissioned report is warning. The report says citizens must pay more and doctors must alter their behaviour. Failure to do so could add 66 billion euros a year to France's public budget deficit by 2020, it adds. The warning comes after thousands of health workers protested on Thursday over staff shortages and the "creeping privatisation" of the health system. The report was written by the High Council for the Future of Health Insurance, an advisory body set up by the government as it prepares to introduce healthcare reform legislation in June. The council also highlights the CSG welfare levy - a charge paid by workers, the unemployed and pensioners - as an area for possible reform. "The High Council is unanimous in its refusal to turn to massive indebtedness to cover the growth in health insurance expenditure," the report said. Problems in the French health system were exposed last year, when a heat wave killed around 15,000 mostly elderly people. There was also a bed shortage in hospitals in December, when a nationwide flu and bronchitis epidemic broke out.

To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don't have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that's typically 40% of income. Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation.

Many French doctors, in fact, earn more by increasing their patient load, or by prescribing more diagnostic tests and procedures—a technique, also popular in the U.S., that inflates health-care costs. So far France has been able to hold down the burden on patients through a combination of price controls and increased government spending, but the latter effort has led to higher taxes for both employers and workers.

That's why France is gearing up to make changes. It already requires patients to register with a general practitioner before visiting a specialist, or else agree to a lesser reimbursement, much like many U.S. insurance plans."

French doctors go on strike to demand reintroduction of compulsory out of hours work

"Emergency services at public and university hospitals in France last week began a "general and unlimited" strike, organised by the French Association of Hospital Emergency Doctors. Joined by nurses, administrators, and ambulance drivers, the striking doctors are asking not only for more staff, better working conditions, more beds, and more money but a revamp of France's entire emergency and out-of-hours care system. They are also complaining that doctors with private practices do not carry out enough out-of-hours work during evenings, weekends, and holidays, forcing patients to use hospitals instead. They want to see a system introduced whereby most general practitioners with private practice are obliged to do out-of-hours work. Doctors complain that on-call work adds to an already burdensome 55 to 58 hours of work a week, according to the Private Doctors Union."

The public health insurance system covers about 75% of total health expenditures.

Half of the outstanding amount is covered by patients' out-of-pocket payments and the other half is paid by private health insurance companies. These supplementary health insurance policies can be taken out by individuals or groups.

Once varying depending on the fund, disparate reimbursement rates were replaced by uniform rates. The funds are financed by employer and employee contributions, as well as personal income taxes. The latter's share of the financing has been ever-increasing in order to:

* compensate for the relative decrease of wage income,

* limit price distortions on the labor market,

* and more fairly distribute the system's financing among citizens.

In the hope of curbing consumption and expenditures, copayments were implemented and have increased over time. These copayments are relatively high for many out-patient services.

For example, patients must pay 30% of Social security's tariff for a physician's visit

Roughly 40% of specialists and 15% of GPs are allowed to charge more than the tariff.

Specialists who have spent at least four years practicing in a hospital are free to charge what they want, and some charge upwards of $675 for a single consultation. 

Copayments are also high for dental prostheses and eye-ware. This tended to deter the poorest citizens (few of whom had supplementary insurance) from seeking care."

  1. The nation's system isn't quite as superb as Sicko maintains, but it's pretty good - Business Week
  2. France - Guide Health Introduction
  3. France - Guide to Medical Costs
  4. France must make big changes to its health system
  5. French doctors go on strike to demand reintroduction of compulsory out of hours work
  6. The French Health Care System - access to care

 

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Comments

I see you have discovered color!

But yes, highlighting really helps in blog posts.

The devil is in the details but also check your sources. The lobbyists have been out in full force trying to ridicule other health care systems. The World Health Organization has a report on differing systems and also I found some very good data at the OECD.

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Yes color and it works great!!

As before most of my sources are from Europe. I tried as best I could to use European sources so that there wouldn't be any conclusion of tainted information.

On the French post there was one from Business Week and the remainder were European sites such as the BBC.

What I have found is that in Europe papers they are willing to post the negative stuff on the different plans. Things that the USA papers will never print. I guess if you want to find the nity gritty dirt you go across the pond.

When I get to the UK is when you will see the dirty and the complaints from UK citizen groups.

Another thread that I will address at the end is that there are few if any government plans that are not wrestling with health care inflation and financing. It is a worldwide problem and I suspect, as we make gains on mortality the problem will get worse.

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Insurance is the issue

How many people know how much their doctor's visits, lab tests, etc. actually cost? How many people price-compare or shop for the best values in health care? I'm willing to bet that virtually no one does. One of the biggest problems with health care is that there is virtually no competition because people rarely shop around. Why don't they shop around? Because their insurance pays, not them. This leads to a distorted market.

What would be a good solution? I can't really answer that. I am personally opposed to most types of insurance. I can see a need for health insurance in certain cases. I carry catastrophic insurance for myself and my family. I pay cash for most services though. It's a consequence of being a small business owner. It has forced me to shop around when looking for health care, though. In the end, I'd much rather pay cash for my families' doctor's visits than have a socialized system (including private health insurance) where I am forced to subsidize my hypochondriac neighbor's weekly (or sometimes daily) visits along with the accompanying medications.

Unless there are some price controls put in place, nationalized health insurance won't be any better than the current system. People need to be aware of how much they are paying for services, or the system will never work. It will just be more of the same.

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No. Living is the issue.

I'm opposed to most health insurance too, mainly because they are a profit model. You said,

Unless there are some price controls put in place, nationalized health insurance won't be any better than the current system.

Tell that to the 46 million (est.) uninsured and under insured in the country. Also, do you think having private or group insurance makes you more likely to be a hypochondriac or something? Get real, man, shit happens to people and it's pretty damn scary when it does. I know, I've been there, done that.

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You must ask why they are uninsured

"She does agree that more people are falling through the cracks of the system these days, and the numbers of uninsured are rising. But on a trip to Brussels last week, she came across a study which found that among Europeans, Germans are the most dissatisfied with their own system, although many studies show it to be among the best in Europe. "

Notice how even in the socialized countires uninsured is rising.  Why?  Because there are and always will be people that don't want to pay to participate.

Since 85 percent of America has insurance that means 15 percent are not insured.

In my State a family of 3 can earn $83,000 a year and still put their child on SCHIP.  What the heck?  There is a real philosophical problem when sopmeone earning $83,000 a year isn't willing to buy a $100 a month insurance policy for their child.

The Uninsured And The Affordability Of Health Insurance Coverage

"the number of people without coverage is much closer to point-in-time estimates and well above full-year estimates. In its most recent release, the Census Bureau stated that its estimates were more closely in line with point-in-time estimates of the uninsured."

Even the census bureau are starting to consider that the much ballyhooed 46 million uninsured my be just a snapshot.  A person that is uninsured for a few days or weeks and we hear stats that sould like 46 million is a static statistic.  Not so.

When I get to Germany you will see some information such as this and it points to a very, very sticky situation in some of the Europeon models.  A situation where the elite, the people that due to income can opt out of the public system are treated better than their brethern in the public system.

 

"Private patients are preferred, publicly insured patients are brazenly turned away, just gotten rid of," Heinz Windisch, president of VKVD, an interest group for both privately and publicly insured individuals, told the newspaper.

 

All this has led to accusations that patients in the public system are second-class citizens, having to wait months for non-emergency doctor's appointments or procedures and paying ever more out of their own pockets as the list of covered treatments and medicines shrinks, all the while watching as their monthly health insurance contributions continue to rise"

 

Economics addresses risk and the acceptance or managment of it.  As Ira Precible said above, people do not shop.  I also feel people don't know how to manage risk.  Why the heck would I want to pay someone (insurance schemes) a large amount of money so I can have a small doctors copay?  I too have been self employed for a long time and have needed to manage my health care.  I pay my doctors office visit.  It is $78 to see my doctor.  Will I be going to a doctor paying $78 for him to tell me I have a cold.  I don't think so.  But people that have a $15 copay could care less about the cost to hear their Dr. say it is a cold.

 

Medicaid health insurance in my State goes as low as a $5 copay.  Now those people have no idea about cost because it is almost entirely "free" to them.  Medicaid rules allowed nominal co-pays (i.e., $3 per service).

 

Gotta go.  I'm in an e-mail fight with someone that supports the Patriot Act.  A law I consider to be Orwealian (sp).

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Two reasons for uninsured:

1) currently because reliance on employer provided insurance - high unemployment; and

2) employers cutting back on offering health insurance because of high cost.

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Just one little point:

"There is a real philosophical problem when sopmeone earning $83,000 a year isn't willing to buy a $100 a month insurance policy for their child."

If you've got a child with CP, it's more like $500-$1000/month to put that kid on insurance.

And that's for an untreatable disease where the damage has already happened!
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Oh I am sorry that I wasn't clear

I meant that someone with a healthy child. A non healthy child can be on SCHIP.

I was only pointing out the arrogance of someone that can afford to pay for their own and putting their child on SCHIP.

Those childhood diseases. I still remember getting my son the sweat testing for CF.

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For Cerebral Palsy

The only real diagnosis available is an MRI.

We got lucky- Shriner's refered him for it, and it didn't need to go on our insurance.

But now that he has the diagnosis- EVEN THOUGH THE DOCTORS CAN DO NOTHING FOR HIM- it's being treated as a pre-existing condition. Drives me crazy. There's no cure. Only workarounds for his symptoms, and the public school system is handling that (as they should, it's education, not medicine).
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Executive compensation is inversely proportional to morality and ethics.

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Maximum jobs, not maximum profits.

You are discussing one of the big problems in

the current system. See my blog today on Germany. If you choose a private plan in Germany, if you have a pre-existing condition and can't get a Private plan, you can get one with an extra tarrif (their word). In other words you can't be turned down and there is always a plan for you. They have to have such a thing because in Germany it is illegal to not have health insurance.

In my State BSBC (or is that BCBS) does have a guaranteed type of policy and it isn't really that expensive. Now I don't live in that insane State of California so if you do....it would be expensive. I've always wondered why California mandates insurance companies to pay for sex change operations and the counseling before and after the change.

"San Francisco is about to embark on another first in the nation: providing health care benefits for city workers undergoing sex-change procedures. Changing sex doesn't come cheap. For males changing to females, surgery costs about $37,000. The surgical costs for females becoming males runs considerably more, about $77,000. The proposed city health benefit for sex-change procedures caps at $50,000 per person for life."

But I guess it is only money the problem is it is other people's money.

As someone that was once diagnosed by a stupid Dr, with an illness and later after a second opinion it was found he was wrong.  I am guessing you've had second opinions on the CP?  My nephews son has CP.

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I'm in Oregon

And after BSBC, Healthnet, and Providence turned me down for their so-called "guaranteed" plans, I'm turning to the provider of last resort, OMIP (Oregon Medical Insurance Pool). They *might* have an option for me, if I can submit enough paperwork to prove I can't get insurance any other way.
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Executive compensation is inversely proportional to morality and ethics.

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Maximum jobs, not maximum profits.

There are supposedly three "universal" plans in Oregon

The first, the Oregon Medical Plan, is income means tested- and due to budget cuts, this so-called "universal" plan only ended up covering you if your family was earning less than 50% of poverty level.

The second, the Children's extension to OMP, is funded by cigarette taxes- but you've still got to be earning less than poverty level to get your kids on it.

The third is OMIP, and it isn't means tested- but it is extremely needs tested, being only for people with pre-existing conditions who can't get on any other plan (and thus, you've got to spend a lot in application fees on other plans before you can get on it).

None of them live up to the promise that OMP was supposed to be to begin with.
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Executive compensation is inversely proportional to morality and ethics.

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Maximum jobs, not maximum profits.

I think you misunderstood my post

I have been uninsured before, and currently have minimal (catastrophic) insurance for myself and my family - some would call in under-insured. I would love to have more coverage, but the insurance system is set up to punish small businesses and individuals the most. What this has taught me is that shopping around for services and prescriptions can save a good amount of money, as can telling health care providers that the costs are coming out-of-pocket.

Those that have a small co-pay never know what the costs are. There is no price competition because there is no incentive to shop around. This allows the costs to spiral out of control, causing insurance prices to spiral at the same time.

I understand that bad things can happen, and diseases can be catastrophic mentally, physically, and financially. To me, the ideal national insurance policy would keep these possibilities in mind when being developed, while minimizing the possibility of abuse. In some ways, the 'health accounts' set up by a previous administration were good because of this.

One of the reasons health insurance costs so much is because of frequent, unnecessary visits and testing. There is a place for reasonable preventive care but there is also a point where it is no longer preventative and is perhaps more psychiatric. And no, I don't think health insurance causes people to be hypochondriacs. It certainly enables those who are though.

This is an economic argument, however, not an emotional one. When people abuse the system, it costs the rest of us money. Why should I pay over $12K/yr when my family only uses $500 of services (we actually use less)? I understand that's the nature of insurance, and that's the reason I pay more than I use now. There are logical upper limits, however. At some point, I'm better off putting money into the bank instead of throwing it to an insurance company.

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testing

I think diagnostic tests are one of the things insurance tries to not cover and to me, that's critical. Without testing there is misdiagnosis, no diagnosis.

I think costs are absurd though. Like to even get a blood sugar meter, the paper is beyond spendy. No way should it cost as much as it does and there are so many things like that.

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No argument about the cost

My 15 year old kid needed a physical for tennis this year. Not a CBC lab type physical, just the cough, cough type. We were in there for 10 minutes and it was $179.

To top it off, he made the team last year but this year didn't make the cut. So it was all for nothing. Next year he tries out first and then if he makes it I'll get the physical.

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If by accounts you mean HSA...I have one

and it works fine for me.

I have enough in my HSA account that basically I have first dollar coverage. The difference is that instead of paying the extra money to the insurance company for them to set up a reserve account, I paid it to my account.

We have seen how badly the American people handled their personal credit and financial situations. Sadly I would guess that the normal American could never manage an HSA. They would never put any money in it. Instead you would find that nice 50 inch LCD TV hanging from their wall.

BTW ...don't feel punished. In reality I think a company that has over 50 (maybe 100) employees they must have a plan that has even more mandated benefits (higher cost). So you and me with individual policies will be paying less than that mandated plan.

The senior center that I volunteer to play piano has a real great deal for a certain doctor. Every two weeks the doctor sends someone to cut some senior toenails. The cost is $100 for each clip and guess who gets billed? Medicare. Since Medicare has a very, very minimal fraud or claim review system, the claims get paid. Great deal for the old doctor bad deal for the taxpayers. If it weren't for the tort system, I would cut the darn toenails for $25 a clip and still be a happy camper.

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Here are some facts about healthcare

Link

Our health care system is broke when you have millions of people uninsured.

It is broken when you have an elderly couple needing $300,000 saved just for medical expenses.

It is broken when you have a major cause of personal bankruptcy is health care costs.

It is broken when health care costs amount to 17% of GDP and still have millions uninsured.

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I absolutely agree.

And I also agree with Seebert's comment above. I believe that access to basic healthcare is a citizen's right, or it should be in this country. I don't know where you draw the line with things like hip replacements, cochlear implants, heart transplants, and that kind of stuff. But I do know that every expectant mother is entitled to access to pre-natal care. And every child is entitled to regular pediatric care, regardless if the mother accessed pre-natal care. A child of a crack addicted or alcoholic mother did not choose its parents. They are human beings with human rights. That is my starting point. Any discussion of health care efficiency, or cost containment, IMO, must start from this premise. Free market health care works pretty well though for those that are healthy enough not to need it or those that need it and can afford it. For all of our posturing of superiority to the rest of the world, we should be embarassed about our standing. We need some serious, serious reflection about who we want to be as a nation; and let's not start from the standpoint that free markets are all that good. They are not, as is being proven right before our lying eyes. Let's face it, some things like healthcare, basic banking, electricity, railroads, et al, are better off being treated as public utilities. We need to start thinking of each other as Tribe Americana.

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I really didn't start this post for moral arguments

It is pure economics. After I get through all the countries you really will see that most all countries are moving away from full coverage. They are adding massive cost controls, utilization reviews and health plans that are deep in debt.

Plus there are socialized plans that people don't provide what everyone is clamoring for in the USA. Japan has very little preventive care, they don't cover pregnancy as a complication, etc.

Ya all got some learn'in a-comin of what the world is really like. It isn't necessarily what you have been told it is like. It is why I am doing this ...kind of a teaching program.

Why do people get upset when they find out there is no Santa Claus?

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When economics gets divorced from morality

Then fraud becomes the most profitable business plan.

I think that's what we're seeing here.
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Executive compensation is inversely proportional to morality and ethics.

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Maximum jobs, not maximum profits.

After I present all the plans

then we can start to talk about which ones are efficient and what we can head toward.

When it comes to health care, efficiency is an oxymoron. Trying to save your arm, your life, your baby and nobody is going to worry about being efficient.

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Just hold your fire

because you are going to find out the infant mortality argument is not a barometer. It will be part of the Japan plan. "infant mortality rate and life expectancy at birth are no longer proper indicators for evaluating a health care
system. " It will have a link to the Japanese report that was Funded by:

The Policy and Human Resources
Development Trust Fund
of the Government of Japan

Also (you can do the homework) there are countries that don't even count a baby unless it was alive for a certain amount of time. I believe in the USA if the baby is out of the womb, it is counted.

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Economics

Look at the US car manufacturers across the border in Canada. That was an economical decision due to health care.
My friends in the UK and Canada look in horror at my history with health care or lack of it in the US and I am still healthy in my 60's on medicare. Just being part of the system has been my largest bill for years. You will see age become a factor even if you are healthy when your company pays for your health care. If you are self-employed, it will be a larger factor as you age. Do not expect US health insurance companies to provide "change".

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