Health Care Under French National Health Insurance

Abstract

Prologue: The United States has traditionally looked to the United Kingdom, its cultural parent, when studying alternative social and political models. Health care is no exception. In the early 1980s Canada s health care system as well came under American scrutiny, and Germany's followed by the end of the decade. In this paper authors Victor Rodwin and Simone Sandier turn their attention to the less frequently studied model of France. “The French health system is a model no less worthy of study than the British, Canadian, or German systems, ” they assert. Rodwin has suggested that “formidable linguistic and cultural barriers” to date have discouraged widespread study of the French system; yet this system is in many ways particularly relevant for American consideration. Fee-for-service reimbursement, total freedom of provider choice, an important private for-profit hospital sector, and patient copayments exemplify a principle of “liberalism” that some Americans find missing in the British and Canadian systems. However, a principle of “solidarity” nourishes a national health insurance system that provides nearly universal coverage, and stringent government price controls keep price levels well below those of the United States. The French public/private mix offers unique possibilities for U.S. study — all the more so since outcome and performance indicators, as well as public opinion on the health care system, are more favorable than in the United States. Rodwin is director of the Office of International Programs and associate professor of health policy and management at New York University's (NYU's) Wagner School. He codesigned and directed (1986-1991) NYU's Advanced Management Program for Clinicians. Sandier is research director at the Centre de Recherche, d'Etudes et de Documentation en Economie de la Santé (CREDES) in Paris. She is an elected member of the (U.S.) Institute of Medicine. Abstract: Several elements of the French health system—the predominance of office-based medical practice, the mix of private and public hospitals, the use of patient cost sharing, direct payment of physicians by patients, and financing derived from payroll taxes—closely resemble aspects of the U.S. health system. There are four major differences between the two systems: the French system covers more than 99 percent of the population; the prices of health services in France are lower than in the United States; the volume of most services is higher than in the United States; and French health care spending per capita is lower than in the United States. Recently enacted and proposed reforms in France likely will strengthen existing health spending targets and utilization controls.

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