Transcript French and the United States Health Care Systems

French and the United States
Health Care Systems
H 533 – Fall 2008
Group Project – Critical Comparison
Sarah Stark, Joe Fisher
French and the United States
Health Care Systems
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Liberté, égalité, fraternité
Life, liberty, and the pursuit of happiness
Sécurité Sociale
Employment based voluntary health insurance
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Health Insurance Europe/France
Early Years
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Germany, under Chancellor Bismarck (1883)
Other countries (late 1800's, early 1900's)
France (1910) – Mutual Aid Societies
Britain (1911)
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World War I (1914 - 1918)
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Alsace-Lorraine (1919)
Social Insurance and Medical Charter (1930)
World War II (1939 - 1945)
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Health Reform USA
Early Years
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American Association of Labor Legislation (1907)
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The 1915 AALL bill and battle (1918 - 1921)
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US enters World War I (1917-1918)
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Great Depression (1929 – 1939)
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FDR's 2nd Deal: Social Security Act (1935)
World War II (1939 – 1945)
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Senator Wagner's Health Bill (1939, 1943)
Truman's Proposed Health Program (1945)
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Health Insurance France
Recent Years
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Sécurité Sociale (1945): ~50%
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Mutual Aid Societies: Supplemental Insurance
Charles de Gaulle (1960): ~76%
Great reform (1980): ~99%
Universal Coverage (2000): ~100%
(2005) 11.2% GDP,
~ $0.25 trillion, $3,926
per person
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Health Reform USA
Recent Years
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Wage Funded and Fraternal Orders
Blue Cross (1930) and Blue Shield (1940)
Medicare/Medicaid (1965)
HMO's (1973) and PPO's
EMTALA (1986) and SCHIP (1997)
(2005) 15.2% GDP,
~ $2 trillion, $6,347
per person
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France and the United States
Health Care Funding
France
United States
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Source: Jean de Kervasdoué, ed., Le Carnet de santé de la France en 2000, note, p. 89; Blue Cross Blue Shield
Association, Medical Cost Reference Guide, p. 30.
Analyzing the French Health System
Publics View of Their Health System
United
States
2007
Satisfaction Indicators
Fundamental
Changes Needed
42%
25.5%
60%
48%
Completely Rebuild
the System
10%
7%
29%
34%
Minor Changes
Needed
41%
41.9%
10%
16%
Harvard-Harris-ITF (1990). Ten Nation Survey
Eurobarometer (2003)
The Commonwealth Fund (2007)
France
2003
United
States
1990
France
1990
Comparison of Access Indicators
Indicators of Access
France USA
Percent with health coverage, excluding
under insured
99.8%
65%
Percent of chronically ill who report lack of
care: Access problem because of cost
(Commonwealth Fund 2008)
23%
54%
Rank for Distribution of Health in
Population (WHO 2000)
12
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Weiz, D. Gusmano, M.K., Rodwin, V.G., & Neuberg, L.G. (2007)
Comparison of Quality Indicators
Quality Indicator
France
USA
Rank of Responsiveness (WHO 2002)
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Percent of Chronically Ill who reported lack of
care due to Coordination Problems
22%
(Commonwealth Fund 2008)
34%
Percent of Chronically Ill reporting
Medication, Medical or Lab Error
(Commonwealth Fund 2008)
18%
34%
Mortality Amenable to Health Care: Deaths
preventable with care
(Commonwealth Fund 2008)
65 per
110 per
100,000 100,000
Comparison of Financial Indicators
Financing Indicators
France
USA
Fairness in Financing Rank (WHO 2000)
26-29
54
Health care Spending per capita Rank
(WHO 2000)
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Out of Pocket Payment as % of National
Private Expenditure on health (WHO 2005)
33.2 %
23.9 %
Total expenditure on Health per capita
(WHO 2005)
$3,819
$6,350
Health Care Expenditure as percentage of
GDP (WHO 2005)
11.2%
15.2%
Strengths of the Systems
France
United States
Universal coverage
Innovative technologies,
medications and treatments
encouraged
Coverage for health
prevention and emphasis on
general practice
Complementary health
incorporated into system
High degree of consumer
choice
High-quality services available
for those with good insurance
or enough personal resources
At the forefront of clinical and
technological breakthroughs
for numerous diseases
Large number of specialists
Weaknesses
France
United States
Future of financial
sustainability unknown
Barriers to health care
increasing
Decision-making and
governance requires
participation from several
parties, and can be timeintensive
High costs, cost-shifting and
insurance pools
Cost-control is difficult
No emphasis on general
practice, preventive health or
complementary health
approaches
Little choice
Lessons from France
1. Universal coverage possible without “single payer”
system.
2. Universal coverage can be achieved without “Big Bang”
reform.
3. Universal coverage can include private insurers in
supplemental insurance market.
4. National responsibility for entitlement may be more
equitable than leaving decisions up to local authorities.
5. Financing universal coverage can be solved before
meeting modernization and reorganization challenges.
Rodwin, Victor G. (2006). The health care system under French National Health Insurance: Lessons for health reform in the United States. Universal Health Insurance
in France: How Sustainable? Essays on the French Health Care System. Washington DC, Embassy of France, 2006.
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