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Health care in France gets top marksBy: Ray Moseley Quality praised, even as some lament costs PARIS -- David Burgess, 56, an American living in Paris, describes himself as "positively a right-winger," and he came to France 18 years ago with an aversion to its socialized health-care system. Most of all, he resented the steep price he was forced to
pay for it: about $438 per month. On top of that, $384 goes out of his
monthly paycheck to cover his French pension. But in the past 2 1/2 years, Burgess' resentment has
evaporated under the impact of an illness that almost cost him his life.
He developed cancer of the esophagus and was told the mortality rate was
about 85 percent within the first three years. But so far he has fought it, boasts that his care has been
superb and says the only out-of-pocket expense he has incurred amounted to
$6.50. "I'm not sure what it was for, but I paid it," he said.
"I no longer complain about my taxes." A friend who is dean of a New England medical school told
him equivalent treatment in the United States would have cost about
$700,000. "I have nothing but praise for the French system, for
the doctors and nurses and the quality of care," Burgess said.
"I used to think I was paying a bloody fortune, but the French system
saved my life. I don't know what it is like in the U.S., but if I lived in
England, where the system is not as good, I would be dead now." The World Health Organization in Geneva rates national
health systems by a variety of criteria, and on all scales France is among
the world's leaders. U.S. ranks 37th In overall performance--relating achievement to
expenditure--France ranks No. 1 in the world, the U.S. 37th. All 15
nations of the European Union, with similar systems, fare better than the
U.S. in the WHO ratings--even Britain, whose underfunded system is widely
criticized in Europe. All are based on the premise that every resident is
guaranteed the same quality of health care, by contrast with the U.S.,
where 40 million people have no health insurance. This represents a major philosophical and cultural
difference between Europe and the U.S., and whether Americans would ever
accept such a concept is open to debate. A bill expanding the rights of
patients in dealing with their health insurers recently passed the Senate
but faces an uncertain future in the House. Former President Bill
Clinton's ambitious universal health-care plan died in Congress in 1994. Critics of the European system point out that it has its
downside: While the cost to workers is high, the burden is even greater on
employers, who have to contribute three times as much as their employees.
This can make them reluctant to take on workers in lean times,
contributing to higher unemployment. But there is no public debate in Europe about this. People
may complain about the way health systems work in practice, and
governments worry about rising costs as their populations age. But the
principle of universal health care is widely accepted, even though it
takes an average of 40 percent of a worker's pay. "Overall the French are satisfied with the system and
want it maintained," said Edouard Couty, a senior official of the
French Health Ministry. "It is very important sociologically." Dr. May Mabro, a doctor at the suburban Foch Hospital in
Paris who has treated Burgess, said there is an official list of 30
serious illnesses for which hospital patients pay nothing. The list covers
all types of cancer, diabetes, heart disease and other ailments. Same care for all The hallmark of the system, she said, is that it
guarantees "the same quality of care for all, regardless of social
level or income. When people are ill, we don't look at how much money they
have." The system even pays for taxis to bring people to the
hospital, and take them home, regardless of ability to pay. "I think this system is not perfect," Mabro
said. "The system is sick because it is too costly. Perhaps people
who can afford to pay something should do so." Mabro said many French people feel coddled by the system and abuse it. They mistrust a doctor who prescribes inexpensive
medications, she said, because they think costly medicines must be better.
Generic medicines, only recently introduced in France, are not popular. She recalled that a government TV campaign 10 years ago
tried to make patients more responsible, for example urging them not to
take an ambulance if they could come to the hospital in a car. "This
was unpopular, so it was stopped," she said. Likewise, Mabro said some doctors order examinations that
are not necessary. While Burgess, a copy editor for the International Herald Tribune, got into a hospital a day after his illness was diagnosed, Mabro said in many outlying towns, it may take a month or longer to gain admission to a hospital. Even in Paris some people have to wait three or four weeks for
surgery, she said. Pay for doctors Like all the staff in her hospital, Mabro is paid by the
hospital from an annual budget allocated by the government. A doctor with
two or three years of practice can earn about $49,000 a year. A Health Ministry official said such doctors can boost
their incomes by up to 30 percent by seeing private patients. More senior
doctors, he said, can earn about $76,000 from their hospital work. These may seem modest pay levels by American standards,
but they compare well with those of lawyers, other professionals and
senior executives in France. Still, there is dissatisfaction among doctors
over pay. "We are asked to provide higher and higher quality
care and more costly therapies," Mabro said. "But the budget
from the state stays the same." The French system clearly works best for those with
life-threatening or long-term illnesses that are hugely expensive to
treat. With 100 percent coverage of costs, no one need worry about ruinous
medical bills. Even illegal immigrants are entitled to such treatment but
can find themselves expelled afterward. The Health Ministry's Couty said the system needed to be
adapted to focus more on care of the elderly and treatment of Alzheimer's
disease as the population ages. At present France has only one specialized
public hospital for Alzheimer's patients. Helping the elderly Under a law taking effect this spring, the government will
devote more resources to helping the elderly stay in their own homes and
to give them better care if they must go into institutions. Local
governments now cover the full costs of care for the elderly, then claim
the money back from patients' heirs when they die. "It can be almost
the entire inheritance," Couty said. The new law will put a $42,000 ceiling on the amount the
local government can extract from heirs. In the mid-1990s, the entire social security system was
$12.5 billion in the red. The government raised taxes steeply to overcome
the deficit, and there was hardly a murmur of public protest. "The
French are very attached to the system," Couty said. There may be no one in France more attached to the system
than that one-time skeptic, David Burgess. But even he agrees that, in at
least one respect, it falls short of perfection. "The only criticism I have is that the hospital food
is absolutely disgusting," he said. "Even the doctors and nurses
agree it's a national disgrace." |