There are three main health insurance schemes in practice. These are: • The general scheme (Regime general) covers employees in commerce and industry and their families (about 84% of the population) and CMU beneficiaries (estimated on 30 November 2001 to be 950 000 people or 1. 6% of the population). • The agricultural scheme (MSA) covers farmers and agricultural employees and their families (about 7. 2% of the population).
• The scheme for non-agricultural self-employed people (CANAM) covers craftsmen and self-employed people, including self-employed professionals such as lawyers etc (about 5% of the population) (Sandier Paris & Polton, 2004). In France, health insurance falls under the Social Security system. 60 percent of the fund is derived from workers’ salaries and the rest by indirect taxes on alcohol and tobacco as well as from a percentage of all revenue proportional to income such as retirement pensions. More than 80 percent of French people have supplemental insurance which in most cases is provided by their employers.
Taxes are used to finance the poorest and provide them with absolutely free universal healthcare. Not just this, but people who suffer from long-term or chronic illnesses are completely reimbursed for their treatment costs. An important reform recently took place in the form of the Universal Health Coverage Act (CMU), which was passed in June 1999 and came into force on 1 January 2000. This act, as its name suggests, establishes universal health coverage, opening up the right to statutory health insurance coverage on the basis of residence in France.
Furthermore, those whose income is below a certain level (currently 1. 8% of the population) are entitled to free coverage. The old system of individual insurance, with contributions that could be financed by the general councils (according to income scales that varied from one department to another), has now been replaced by a system based on the right to health insurance and the logic of social protection through insurance rather than state aid(Sandier Paris & Polton, 2004). Organization of the Healthcare system:
The French government has the prime responsibility for the health and social protection of all its citizens and regulates the healthcare system closely. Specifically, the state underwrites the training of health personnel; defines working conditions; regulates the quality of health service organizations; monitors safety; regulates the volume of health services supply; and oversees social protection. It manages and intervenes in the methods of financing: setting tariffs, determining coverage of the population, and regulating relations with health service producers (Green & Irvine, 2001).
According to the French Embassy in the U. S. , there are 3,171 healthcare establishments in France which provide 4,857,698 hospital beds for long-term care and 45,727 beds for short-term care. In this, the distribution is such that there are 1,032 public healthcare facilities (315,687 beds) and 2,139 private for profit and not-for-profit healthcare facilities (170,382 beds) (The French Healthcare System). The number of doctors in France has been on the rise and today there are 3 doctors for every 1000 people. This ratio is comparable to other Western countries: Great Britain has a ratio of 3 doctors per 1800 people, the U.
S. has 3 doctors per 2700 people and Germany has 3 doctors per 3400 people. The presence of women doctors in the fraternity is also on the rise. Women doctors account for more than 40% of all practicing doctors (The French Healthcare System). Hospitals in France are of three types: public, private profit-making and private non-profit making. Almost two-thirds of all hospital beds are in public hospitals. Public hospitals tend to be larger than private hospitals, are generally well-equipped and provide facilities for research and training of medical students.
The main types are (a) regional hospitals which are large organizations usually based in cities with university medical schools, (b) hospital centers, which are found in Department capitals and many of these provide specialized care for certain conditions such as mental illness or cancer, and (c) local hospitals. , which provide basic care and are not as well equipped as regional hospitals. Private non-profit hospitals generally deal with medium- to long-term care. They have the same obligations as public hospitals, follow the same rules of operation, and financing, except those regarding the employment of staff.
They include around twenty specialist cancer centers. In 1998, this sector had 24,782 beds. Private for-profit hospitals focus on acute care and particularly surgery. There are many small establishments, although there has been a recent move towards concentration. This sector represents 20 per cent of the total hospital capacity. In 1998, there were 98,813 for-profit hospital beds in France. Health Care Expenditure in France: In 2000, total expenditure on health care in France was estimated at €140. 6 billion or 10% of GDP. Health care consumption accounted for €122. 2 billion or 86.
9% of total health care expenditure, giving an average of €2020 per person. The figure for total health care expenditure also includes expenditure on prevention (2. 4%) and activities related to research (4%), teaching (0. 5%) and health administration (1. 7%). Again taking figures for 2000, 72. 8% of total expenditure on health care was financed by social security, 12% by complementary VHI (7. 8% by mutual insurance associations, 2. 4% by private insurance companies and 1. 8% by provident institutions), 9. 7% by private households and 4. 4% by the state and local authorities (Sandier Paris & Polton, 2004).
According to OECD estimates published in 1998, France ranks in eleventh place for the level of per capita health care expenditure, but in fourth place for health care expenditure as a proportion of GDP. Taking its wealth into account, France therefore spends more on health care than other OECD countries (Sandier Paris & Polton, 2004). If spending continues at this rate, it is said that the health service may be 70 billion euros in debt by the end of 2020. Part of this cost stems from alleged waste within the system; some sources suggest that patients “shop” for doctors, visiting multiple specialists until they receive the diagnosis they want.
This is because complete freedom of choice of physician and health service provider is one of the distinguishing elements of the French system. Another cause may be the overuse of prescription drugs; one fifth of the country’s health spending goes to pharmaceuticals (Henley, 2004). Comparison with the U. S. healthcare system: The French healthcare system while not without its issues is definitely one of the most effective in the whole world. One of the prime differences between the U. S. and France healthcare systems is that large number of Americans access limited care because of their lack of health insurance.
France on the other hand has superb health coverage as discussed earlier in this paper. Virtually all physicians contribute to the nation’s public health insurance, Securite Sociale. Also, while the average French physician earns only twice the average French wage (as compared to the average American physician who earns more than five times the average US earnings), French physicians are free from the worries of practice liability or medical school debt. This is because their legal system is to a large extent tort-averse and their medical schools do not charge tuition fees.
France has proved that it is possible to have a universal coverage system without a ‘single-payer’ system. It has demonstrated that a mixture of public and private financing can be used to solve the financing problem. Their entire system is based on one value: that the healthy should be responsible for paying for the sick. National insurance funds, in which every employer and employee participates via contribution, cover the entire population and the government pays for the unemployed part of the population which can not come under this net even through a family member.