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March 25, 2007

The French Health Care System.

It looks like various people are pointing to the French health care system and considering it as one that might provide a suitable model for the US. Ezra Klein for example. Tyler Cowen points to the difference in labour costs as one possible reason why France gets more out of it's health care spending than the US does (as indeed I did some time ago).

But before this all goes any further, can we just get a few things sorted out about the French health care system? From what I see of the current debate in the US there is a desire for, from certain parties, a single payer system. Fine, argue for that, if you want to, but you cannot then use the French system as supporting evidence. For the French system is not a single payer one.

You and your employer pay, from your wages, a sum each pay period into the national insurance system, this is true. It's rather like the various Medicaid/Medicare taxes paid on wages in the US. This is also topped up from the general revenue to cover both those not in work and also the deficits that the system has been running for years.

However, here's the crunch. That national system does not cover the full costs of your health treatment. Here:

The French healthcare system is funded by the working population. French employees pay about 20 per cent of their gross salary � the self-employed pay even more - deducted at source, to fund the social security system, known as S�curit� sociale.. A significant proportion of this money goes towards public healthcare, to which every legal resident of France has access under the law of universal coverage called la Couverture maladie universelle.

Note, please, the sums being paid in. 20% of gross wages (that's just the employee side, the employer pays more again.)

If a person subscribes to S�curit� sociale, part of the cost of their medical treatment is covered by the state.

Note, please, "part of the cost".

Unlike the UK in France treatment, whether private or public, is not free at the point of delivery. Even if you subscribe to the S�curit� sociale, on seeing a doctor or specialist (specialiste) you first pay the full bill (tarif) and are then reimbursed at a later date (about 10 days). Generally speaking, S�curit� sociale refunds 70 per cent of the cost of a visit to a m�decin traitant (a GP or family doctor) and most specialistes.

It covers 70% of the cost (100% for cancer).

Even when you are affiliated to the French system a fundamental principle of healthcare funding in France is the element of personal contribution. To make up the difference between what the state pays and the cost of treatment, most French residents take out an insurance policy to cover the difference (complement). This is called a police compl�mentaire or mutuelle.

Most people have private insurance on top of this state insurance. There is no way that this can be described as a single payer system.

On the other hand someone on regular medication may require a plan that would cover this cost (prescribed medicines are reimbursed 35% or 65% by the state).

I'm not sure about the details of Medicaid and Medicare, but isn't this in fact less generous than those systems?

It is also true that the French system is not a single provider one, analagous, say, to the VA.

Ah, here are the MediCare deductibles. To my untrained eyes those look much more generous than the French system (30% of all costs, remember).

This is the bit that I want to get across. Sure, argue for a single payer system, go ahead. Sure, argue for a single provider one (although I think both ideas are crazy, you're entirely at liberty to argue for them).

But please don't use poorly understood foreign systems to try and bolster your argument. France does indeed have what is generally agreed to be an extremely good healthcare system. But it is not single payer, it is not single provider and, it would appear, is markedly less generous than MediCare.

That would appear to be the lesson from the French system: it works precisely because it is not single payer, because it has high deductibles, which are then met by private insurance or out of pocket.

March 25, 2007 in Health Care | Permalink


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"100% for cancer": so it's not free from the politics of gesture, either.

Posted by: dearieme | Mar 25, 2007 2:21:54 PM

I think "cancer" here is shorthand for long-term illnesses, which I don't think can be described as gesture politics.

Posted by: Matthew | Mar 25, 2007 6:05:58 PM