Transcript Why is the French healthcare system rated first?

By
Nick Kurek
Greg Vander Ploeg
Year
USA
France
World Health
Organization Ranking
2000
37th
1st
Total Expenditure on
Health
2008
15.2%
11.2%
Physicians per 10,000
people
20002010
27
35
Hospital beds per
10,000 people
20002010
39
72
Life expectancy
male/female
2009
76/81
78/85
Heart Disease per
100,000
2006
176
61
Obesity
2006
39.1%
7.4%
Deaths by gun shot
under 19 years old
1995
5,280
109
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The French are focused on preventative care to
lower costs.
Everyone has health insurance.
Insurance usually covers 70 – 80%.
The sicker you are in France, the more coverage
you get.
24 hour Access – can go to any doctor or hospital
and they have same day appointments (even
dentists).
Doctors make house calls.
Mandatory health check ups for children.
Kids aren’t allowed to bring lunches to school.
School cafeterias provide nutritious foods for
students.
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35 hour work week (some work 39 but get a
bonus 4 hours of vacation per week)
5 weeks paid vacation/year plus sick days,
which aren’t counted as vacation days.
11 National holidays
Not burdened by healthcare costs
Funding for raising children
Wine
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The public health insurance scheme accounted for
76.6% of total health expenditure in 2008.
The public health insurance scheme is financed by
employer and employee payroll taxes (43%),
income tax (33%), created in 1990 to broaden the
revenue base for social security;
Revenue from taxes levied on tobacco and alcohol
(8%); state subsidies (2%); and transfers from other
branches of social security (8%).
There is no ceiling on employer (12.8%) and employee
(0.75%) contributions, which are collected by a national
social security agency.
Coverage for those not eligible for the public scheme or
complementary private coverage is mainly financed by
the state through an earmarked tax on tobacco and
alcohol and a 5.9 percent tax on the revenue of
complementary private health insurers.
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Allows any person lawfully residing in France for
over three months to receive this free health
insurance.
Supplementary CMU allows access to care for
people with low incomes and living in France.
Healthcare costs will be covered 100% with no
upfront fees, including the portion not reimbursed
by social security and hospital daily fee. In
addition, you will not have to pay the flat fees.
Illegal aliens are entitled to heath care via the Aide
médicale d'Etat (AME, State medical aid).
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A part of CMS is that you must choose a primary
doctor to see first or else you lose some
reimbursement.
This doctor will do the following:
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coordinates your care for optimal healthcare
Ensures preventative care
Directs care to specialists
Knows and manages your medical record
You may see except a gynecologist,
ophthalmologist and dentist without your
doctor’s referral .
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You are allowed to change your doctor at anytime
you just have to report it
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The French people do have to pay some of the
medical costs (besides taxes) but at really low rates
80% have private health insurance that cover some
of these costs.
Exempt:
Children under 18 years old.
 women supported through pregnancy (required exams
and the exemption period of the first day of sixth month
of pregnancy on day 12 after birth).
 If you are on the universal health insurance supplemental
plan (CMU-C) or medical assistance from the State
(MEAs)
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The co-payment is the portion of health
spending, which remains at your expense after
reimbursement of health insurance. It applies
to all care and medical expenses reimbursed,
whether it be a consultation with a doctor, a
purchase of prescription medications, etc..
Example: Seeing a doctor has a repayment rate
of 70%.
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GP rate is € 23
 You pay € 7.90
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Specialists range from € 25- € 37
 You pay € 8.50 - € 12.10
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The medical deductible is an amount that is
deducted from the reimbursements made by your
health insurance on drugs, paramedics and
medical transportation.
The deductible amount is:
0.50 per box of medicine (or any other package: bottle for
example);
 0.50 per paramedical act;
 2 euros a medical transport.
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Maximum limits
You can only be charged 2 euros per day on paramedical
acts.
 You can only be charged 4 euros per day for medical
transports.
 You can only be charged 50 euros per year for any of the
above.
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To help preserve the French health care system, a flat fee of
1 euro is charged for
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Limits
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all consultations and procedures performed by a physician
Radiology scans
Lab tests.
You can only be charged 4 euros/day per physician
You can only be charged 50 euros/year
This fee isn’t assessed
At the dentist.
Care performed by a midwife.
Care performed by a nurse, a physiotherapist, or speech therapist.
As part of surgery, hospitalization of one or more full days in
hospital.
 For acts performed as part of a screening for breast cancer.
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The flat fee of 18 euros applies:
Acts to which the bill is greater than or equal to 120 euros,
whether performed in the office of town, in a health
center, or in a health facility (hospital, clinic) as part of
outpatient visits.
 Expense of hospitalization in a health facility (hospital,
clinic), including hospital at home (HAH), during which
an act is performed with a therapeutic or diagnostic rate
is greater than or equal to 120 euros.
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Examples
If you have one or several procedures done and the bill is
over 120 Euros the 18 Euro flat fee is applied
 The 18 Euro flat fee is only applies once during a hospital
stay no matter how many procedures you have.
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Apart from cases of emergency hospitalization, you can seek
treatment in the hospital of your choice, both public and
private.
If you are hospitalized in a public or a private hospital,
Health Insurance reimburses your hospitalization 80%
The Health Insurance also supports some of the treatments
performed before or after hospitalization. For example, you
will be reimbursed 70% for a consultation with an
anesthesiologist before surgery, and 60% if you need
rehabilitation sessions after surgery.
During hospitalization, the fixed daily hospital charge
participates in the hospital and applies to all. It is due for
stays longer than 24 hours in a health facility. However,
some reasons for hospitalization may be exempt.
18 euros per day in a hospital or clinic;
13.50 euros per day in the psychiatric ward of a health
facility.
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Your hospital expenses will be fully refunded if you
are in the following situations:
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you are hospitalized more than thirty consecutive days (your
support begins at 100% on the thirty-first day);
you are pregnant and need to be hospitalized for the last four
months of your pregnancy, your delivery, or for twelve days
after delivery;
for your newborn, if hospitalized within thirty days of birth;
you are hospitalized because of an accident or an occupational
disease;
you are hospitalized due to long-term illness;
for your minor child, if hospitalized due to sexual abuse;
you receive a pension for accidents at work (with a disability
rating at or above 66.66%). Your beneficiaries also benefit from
this support to 100%;
you hold a disability pension, a pension of disabled widow or
widower, a pension that replaced your old age disability
pension, or a military pension;
you are covered for Alsace-Moselle;
you get the universal health insurance or medical assistance
from the state.
Dollars
20,000
18,142
18,000
16,000
13,483 13,244
14,000
12,650
12,000
11,112 10,875
10,000
10,441
9,870
8,350
8,000
7,160
6,222
6,000
5,204 5,072
4,000
2,000
0
US*
CAN* NETH JPN*
* 2008.
** 2007.
Source: OECD Health Data 2011 (June 2011).
DEN
SWIZ NOR** SWE
AUS*
NZ*
OECD
Median
FR
GER
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Long term illnesses are covered 100% by health
insurance (surgeries, drugs therapies, ect…)
Examples
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Cancer (every cancer patient can get any drug,
including the most expensive and even experimental
ones)
Multiple sclerosis
Diabetes
Alzheimer's
Psychiatric disorders
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Maternity stays for a normal delivery are a minimum of five days
Mothers are required to take a minimum eight weeks' maternity
leave, but are entitled to a total 16 weeks (usually six weeks prior
to the expected date of delivery and ten weeks after).
Two additional weeks prior to delivery may be awarded in the
case of a pregnancy with complications.
For a third child, leave is extended to 26 weeks (eight pre-natal
and 18 post-natal).
Mothers expecting twins or triplets (or more) are entitled to 12 - 24
weeks' pre-natal leave, and 22 weeks of post-natal benefits.
The Husband gets 11 consecutive days, or 18 consecutive days in
the case of a multiple birth.
Adoption leave is ten weeks, or 22 weeks for the adoption of
more than one child. If the adopted child is at least the third child
in the household, the leave period is extended to 18 weeks.
During maternity/ paternity leave you are paid 100% of your
salary.
There are several family benefits. Depending on income, you get a
certain amount of money for giving birth/adopting, day care,
school, and get monthly payments until your child is 20.
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The French approach is to treat the emergency
on-site and vehicles and personnel are
equipped and trained for this. The reason is
that recovery rates are found to be much higher
when a victim is treated as soon as possible.
Ambulances have a two tier system
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Basic EMS run by the fire department
MICU have a Physician, nurse and EMT on board.
These are run by the hospital.
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When you call SAMU they:
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The outcome of this SAMU call center by choosing the appropriate
solution is :
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analyzing calls on patient need
The physician at the SAMU site decides the best solution for the patient's
care
dispatching the most appropriate mobile care resource (MICU,
Ambulance, or Mobile care professional), or
directing the patient to an alternative fixed resource such as primary care
medical surgery or hospital service, or
offering care advice over the telephone
improving the care of patients in live-threatening conditions
avoiding useless medical procedures
avoiding unnecessary hospitalizations
ensuring and simplifying the access to G.P. on duty
monitoring emergency procedures
preparing the reception of the patient at a suitable hospital.
Because of this aggressive triage, calls result in:
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30% get information/advice over the phone
30% send a GP on duty to the site
30% send ambulance
10% send mobile intensive care units (MICU)
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Get paid a lot less than what U.S. doctors get
paid but they get:
Free medical school
 Low taxes
 Low malpractice rates
 Every patient has insurance
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Dollars
Orthopedic surgeons
Primary care doctors
500,000
450,000
442,450
400,000
350,000
324,138
300,000
250,000
208,634 202,771
200,000
187,609
186,582
159,532
154,380
150,000
131,809
125,104
95,585 92,844
100,000
50,000
0
US
UK
CAN
GER
AUS
FR
US
UK
GER
Source: M. J. Laugesen and S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending
for Physician Services Compared to Other Countries,” Health Affairs, Sept. 2011 30(9):1647–56.
CAN
FR
AUS
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France has a better healthcare system than the
U.S.
French doctors make house calls.
Reduced stress = better health.
Wine is good.
SAMU is the French equivalent to 911.
Doctors in France get paid less than in the U.S.
In France long term illness is 100% covered by
insurance.
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http://www.who.int/en/
http://www.globalhealthfacts.org
http://www.commonwealthfund.org
http://www.businessweek.com
http://www.cleiss.fr
http://www.ameli.fr
http://www.samu-de-france.fr/en
http://www.kaiseredu.org
http://www.understandfrance.org
http://www.google.images