October 2, 2008
An outsider’s view of the French health care system
By Lawrence Robinson, M.D.
Several years ago, the World Health Organization rated France as having the best medical care system in the world. In comparison, the United States was thirty-seventh. This summer I spent time in France, in part learning about the French health care system and exploring why it is ranked so much higher than our own. Despite a larger per capita consumption of alcohol (they do have very good wine!) and more smokers, life expectancy is three years longer in France than in the U.S. Perhaps most impressive, the French provide good access to high-quality care for all their citizens while, spending about half what we spend per person per year.
- Per capita alcohol consumption: France 11.4 liters; U.S. 8.6 liters
- Smokers (% of adults): France 32%; U.S. 24%
- Life expectancy at birth: France 81 yrs; U.S. 78 yrs
- Per capita expenditure on health: France, $3,406; U.S. $6,347
I observed three important differences between the French and American systems. First, the single-payer system in France seems to result in considerable efficiencies. With greater simplicity of payment, fewer resources are spent on coding, billing, documentation for billing purposes, collections, and responding to denials. This lowers cost.
Second, most physicians in France receive fixed salaries. Without financial incentives, physicians are less likely to perform expensive procedures unless they are likely to improve outcomes. While physician salaries in France are low compared to those of American counterparts, they are still over twice the French national average salary. And doctors in France have the advantages of lower medical school debt (tuition is essentially free), shorter work hours, and more vacation days.
A third difference between the two health care systems is the absence in France of significant pharmaceutical and biotechnology industry influence in clinical settings. A law prohibits gifts from pharmaceutical companies to health care professionals and there is little or no direct marketing of prescription medications or devices to the general public.
While I’m not sure that the French system can be adopted in the USA, I did learn that we need to remain open to learning from health care systems that have better outcomes than our own.