Tuesday, March 27

France's "Universal Health Care" What is it?

WHO ranks France as #1 in healthcare efficiency and U.S. #37

November 8, 2010, I wrote a piece about "health care in France...", more of a chronicle of our personal experiences with obtaining healthcare in US and subsequently obtaining healthcare in France.  

Once again, debates are heating up about "Obamacare" and what that means. Currently it is with the Supreme Court.  My friends in the U.S. have asked me questions about the French healthcare system, since I am in that system.  So, the following is a more generalized overview of what "socialized medicine" or "universal healthcare" looks like in France...

I don’t know all the ins-and-outs of how the French health care system works, but I believe I can you a general overview.  The universal healthcare in France began in 1945 and is afforded to all legal residents (and currently illegals as well). In other words, no-one can be denied healthcare. Like "Social Security" in the US, it is funded through employers, employees and taxes, or, in our case, premiums paid directly to the state. The fallacy is that the government dictates health coverage; untrue. The state's primarily role is to govern costs through mediation of e.g., union/employers, number of medical facilities/equipment to support the population etc. as well as cost for reimbursements, amounts doctors can charge (assumes they are sector 1 doctors—see below). And, there are two types of hospitals: The public which is about 65% of the hospitals, and private (profit and non-profit oriented). You can choose which to go to, for routine visits or even for an emergency.  If, however, you feel incapable of going to ER, we have what's called "SOS Medecin" which provides 24/7 medical doctors to visit you at home. Sort of like "doctors on wheels."  I have used them and the system is extremely efficient. Your call is answered quickly, and they will tell you what time to expect the doctor. Mine came right on the dot.  The prices are very reasonable, and of course you will be reimbursed based on your insurance program(s).

Doctor's on wheels (24/7)

As a non-EU but French resident you can enroll in the universal healthcare if you choose; however, you can also choose to go private and not use the universal healthcare system at all. In either case, there are no pre-existing condition exclusions and no health history is taken to enroll.The latter although more costly, is still affordable compared to US costs since they are European based insurance companies and do not have all the costly overhead as they do in US.  But legal residents are required to have some form of health insurance (illegals probably don't but they still are covered fully in emergency situations, like Medicaid is supposed to in the US).

So, as for doctors, there are basically 3-types of doctors. Sector 1, 2, and then private:

• Sector 1 doctors agree to only charge the fees approved by the government (e.g. the 'usual and customary' fee US insurance company imagine). So their charges are fixed. For example a general practitioner charges 23€ per visit, and the patient is reimbursed 70% (16.10€) by the healthcare insurance. The prices will vary depending on their specialty, e.g., Dermatologists I believe charge 30+€. Note: if your primary doctor refers you to a specialist, reimbursement is higher than if you went on your own.  But you are free to see any doctor you want (without the referral you will still be reimbursed but at a slightly lower rate).

• Sector 2 doctor are basically "freelancers" and can charge whatever they want. People in the national healthcare system can go to them; however, the reimbursement to the patient is still fixed to the approved tariff. These are usually specialty doctors such as dermatologists, ENT etc. So, for example they can charge 100€, but the government will only reimburse 16€ or whatever the reimbursement rate is for that specialty.

NOTE: you can get a 'mutuelle' (supplemental) coverage, which covers the difference between what is reimbursed and what you pay out-of-pocket. So, for example, you pay whatever premium (or deductions from your paycheck if you work, note: premiums are based on your income, but always affordable or free for the poor), then you can pay a private insurance carrier “mutuelle” e.g., 100€ a month to cover the difference. For example, if you get your eyes checked, then get glasses, it is 100% paid for through the reimbursement through your paid premiums and supplemental.  Just like AARP's supplemental insurance and medicare in the US.  The poor get a 'complimentaire' or free supplemental and thus their medical care costs them nothing.

• Private doctors. They are typically independent, and may or may not take private healthcare. For example, the American hospital in Pariswill accept private insurance and in most cases US healthcare insurance, but their fee structure is extremely high in comparison, so only worth going to if you have really good insurance.  The universal healthcare system might reimburse you at a very, very low rate for these private doctors.
Note: Labs also follow these rules, there are 'usual and customary' tariff labs and also private labs.  Most all labs (and most general practitioners) follow the government mandates (fees) unlike trying to find a US doctor who accepts Medicare or your particular insurance (PPO/HMO).

Pharmacies also fall under the government controlled costs. I can tell you from experience with both US and French pharmacies, even without insurance, it's much, much cheaper in France for the exact same medication. So, basically the choices are yours to fit your needs. Under the universal healthcare system, the government does not dictate what kind of treatment you can have. That decision is made by you and your doctor. For example, in January my doctor recommended a brain scan for “tinnitus”, my doctor simply wrote a prescription. There was no waiting for an approval and I got tested within a week of making an appointment. A prescription pad is very powerful here. In US, I would have to wait for an approval and oftentimes, wait a long period for the actual tests which can only be taken at certain labs. FYI..., been there, done that!

The only involvement the government will have is more “reminders” and free treatments. For example, I got in the mail a reminder last year that I need to get something similar to a Colonoscopy because of my age, which the government pays 100%. Another example, flu shots reminders are sent and are typically free. This is because the universal healthcare system believes in preventive medicine, rather than reactive medicine, which is actually more cost effective.

So, this is it in a nutshell. Again, very generalized. I'm sure you can get more detailed info through "google" research.

Although I am a strong believer in "Universal Health Care", mostly, I want to relay what I know through my experiences, and clarify any fallacies, such as government making health-care decisions (e.g., death panels). 

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