National healthcare - is it for everyone?
I've been asked to give my two centimes about living in a country with an established national healthcare system. What follows below is based on our experiences over the past four years and also research on the French national healthcare website.
Pharmacie Blanchet downtown
Our first visit to a doctor was within our first few weeks in France, before we were on the national healthcare system, commonly called the Sécu. Jonathan was sick and it became obvious quickly that he needed to see a doctor. A neighbor in our building called her doctor and got an appointment for Jonathan for that evening at 7:30, after the doctor's normal hours. We left with a prescription in hand and a form to send in to the Sécu in order to be reimbursed 70% of the 20 euros (about $30) the visit had cost us out of pocket. At the pharmacy across the street we paid less than 15 euros (about $22) for a round of antibiotics, most of which was also reimbursed.
2004 nutshell:
- Easy to see the doctor of our choice.
- 70% of the 20 euros doctor's visit and most of the prescription reimbursed by Sécu. Cost of regular visit: 6 euros (about $9)
Inside a typical pharmacy
I hope you'll forgive me for not remembering the exact date, but at some point after we'd been here maybe a year and a half or so, we received a letter saying that the rules were changing. (Hold your breath...) One euro (about $1.50) of the standard 20 euros visit would instead stay within the healthcare system. For us, this was no big deal. For some of our French neighbors, it was. They loved their socialized system and this seemed to be a compromise to them.
An automated machine for updating your Carte Vitale or checking on reimbursement status
All heck broke loose a year later when the rules changed again and the price of a standard doctor's visit went up to 22 euros. (about $33). It was the talk of the town (or at least among our friends). At this point we'd been here long enough to understand that it wasn't that they were too cheap to pay a couple more euros to see a doctor, but it showed a fundamental change in a system that was intended to provide free healthcare to all.
Another boom hit when people were asked to choose a médecin traitant or primary care physician. They could still see other doctors, but would be reimbursed less than if they'd seen their médecin traitant.
2008 nutshell:
- In order to receive maximum reimbursement, must see your declared médecin traitant.
- 70% of the now 22 euros doctor's visit will be reimbursed, minus 1 euro. Cost of regular visit: 7.60 euros (about $11)
All of this sounds good, but dig a little deeper and it gets ugly. In 2005 the French healthcare system ran a 11.6 billion euros deficit and in 2006 the healthcare system had a 10.3 billion euros deficit. Unless something changes, the party's not going to last, folks.
Pharmacy in the Croix Rousse neighborhood
FAQs
How easy is it to see your doctor?
Very. We have never had to wait to see our médecin traitant. When we call for an appointment he always asks if it's urgent and we need to come in that same day. If so, he will stay late to see us. If not urgent, we can usually see him within two or three days.
Can you choose your doctor?
Yes. You choose a médecin traitant and can change by sending in a form. (Ours is just one building away)
How much do you pay for a doctor's visit?
If we went to our médecin traitant, we'd pay 22 euros today. Within about 10 days Sécu would reimburse us 70% (15.40 euros) minus 1 euro by deposit in our bank account. So in the end we would pay 7.60 euros (about $11).
Are you still really an American if you benefit from France's national healthcare system?
Oui.
What about seeing specialists? Is that hard to do?
No. Your médecin traitant can write a referral for you to see a kinesiologist, dermatologist, etc... If you go directly to the specialist without a referral or to an unrecognized healthcare provider, you will not be reimbursed as much (or in some cases at all).
What about hospital visits?
Thankfully, no first-hand experience here. However the Sécu website says that the patient pays 16 euros per day for hospital stay and 12 euros per day for psychiatric stay. Hopefully, I won't be able to confirm either of those for you.
The big question...is the quality of healthcare any good though?
In 2001 World Health Organization rated France's healthcare system the best in the world because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country's population. The US ranked 37th.
According to a study by the Commonwealth Fund and published in the journal Health Affairs measuring the provision of timely and effective healthcare in developed countries, France is the world leader in healthcare. And we find no reason to disagree.
Big fancy studies aside, what do you really think about it?
We've found it to be good - little odd to us at times, but good. For example, in the US if you have a cold you'll probably go home with cough syrup and some pills. Here it might be a powder to mix with water, some lozenges and an herbal infusion to drink. But hey - it works so I'm not going to knock it. (Just chuckle at it a little sometimes.)
Are you in favor of a socialized healthcare system?
As one who is in the system - I love it. The benefits are great and we've had really good experiences. However, the system we're in cannot hold itself up much longer. Then what? I would be in favor of a smart socialized healthcare system that was designed to take care of my great-grandchildren just as much as me.
Sources:
The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World, by Michael D. Tanner for CATO
France's model healthcare system, by Paul V. Dutton for the Boston Globe
Health Care Lessons From France, by Joseph Shapiro for NPR
Pharmacie Blanchet downtown
Our first visit to a doctor was within our first few weeks in France, before we were on the national healthcare system, commonly called the Sécu. Jonathan was sick and it became obvious quickly that he needed to see a doctor. A neighbor in our building called her doctor and got an appointment for Jonathan for that evening at 7:30, after the doctor's normal hours. We left with a prescription in hand and a form to send in to the Sécu in order to be reimbursed 70% of the 20 euros (about $30) the visit had cost us out of pocket. At the pharmacy across the street we paid less than 15 euros (about $22) for a round of antibiotics, most of which was also reimbursed.
2004 nutshell:
- Easy to see the doctor of our choice.
- 70% of the 20 euros doctor's visit and most of the prescription reimbursed by Sécu. Cost of regular visit: 6 euros (about $9)
Inside a typical pharmacy
I hope you'll forgive me for not remembering the exact date, but at some point after we'd been here maybe a year and a half or so, we received a letter saying that the rules were changing. (Hold your breath...) One euro (about $1.50) of the standard 20 euros visit would instead stay within the healthcare system. For us, this was no big deal. For some of our French neighbors, it was. They loved their socialized system and this seemed to be a compromise to them.
An automated machine for updating your Carte Vitale or checking on reimbursement status
All heck broke loose a year later when the rules changed again and the price of a standard doctor's visit went up to 22 euros. (about $33). It was the talk of the town (or at least among our friends). At this point we'd been here long enough to understand that it wasn't that they were too cheap to pay a couple more euros to see a doctor, but it showed a fundamental change in a system that was intended to provide free healthcare to all.
Another boom hit when people were asked to choose a médecin traitant or primary care physician. They could still see other doctors, but would be reimbursed less than if they'd seen their médecin traitant.
2008 nutshell:
- In order to receive maximum reimbursement, must see your declared médecin traitant.
- 70% of the now 22 euros doctor's visit will be reimbursed, minus 1 euro. Cost of regular visit: 7.60 euros (about $11)
All of this sounds good, but dig a little deeper and it gets ugly. In 2005 the French healthcare system ran a 11.6 billion euros deficit and in 2006 the healthcare system had a 10.3 billion euros deficit. Unless something changes, the party's not going to last, folks.
Pharmacy in the Croix Rousse neighborhood
FAQs
How easy is it to see your doctor?
Very. We have never had to wait to see our médecin traitant. When we call for an appointment he always asks if it's urgent and we need to come in that same day. If so, he will stay late to see us. If not urgent, we can usually see him within two or three days.
Can you choose your doctor?
Yes. You choose a médecin traitant and can change by sending in a form. (Ours is just one building away)
How much do you pay for a doctor's visit?
If we went to our médecin traitant, we'd pay 22 euros today. Within about 10 days Sécu would reimburse us 70% (15.40 euros) minus 1 euro by deposit in our bank account. So in the end we would pay 7.60 euros (about $11).
Are you still really an American if you benefit from France's national healthcare system?
Oui.
What about seeing specialists? Is that hard to do?
No. Your médecin traitant can write a referral for you to see a kinesiologist, dermatologist, etc... If you go directly to the specialist without a referral or to an unrecognized healthcare provider, you will not be reimbursed as much (or in some cases at all).
What about hospital visits?
Thankfully, no first-hand experience here. However the Sécu website says that the patient pays 16 euros per day for hospital stay and 12 euros per day for psychiatric stay. Hopefully, I won't be able to confirm either of those for you.
The big question...is the quality of healthcare any good though?
In 2001 World Health Organization rated France's healthcare system the best in the world because of its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and longevity of the country's population. The US ranked 37th.
According to a study by the Commonwealth Fund and published in the journal Health Affairs measuring the provision of timely and effective healthcare in developed countries, France is the world leader in healthcare. And we find no reason to disagree.
Big fancy studies aside, what do you really think about it?
We've found it to be good - little odd to us at times, but good. For example, in the US if you have a cold you'll probably go home with cough syrup and some pills. Here it might be a powder to mix with water, some lozenges and an herbal infusion to drink. But hey - it works so I'm not going to knock it. (Just chuckle at it a little sometimes.)
Are you in favor of a socialized healthcare system?
As one who is in the system - I love it. The benefits are great and we've had really good experiences. However, the system we're in cannot hold itself up much longer. Then what? I would be in favor of a smart socialized healthcare system that was designed to take care of my great-grandchildren just as much as me.
Sources:
The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World, by Michael D. Tanner for CATO
France's model healthcare system, by Paul V. Dutton for the Boston Globe
Health Care Lessons From France, by Joseph Shapiro for NPR
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11 comments:
That was so interesting! I work for a medical billing company in the US and found this so neat! Thanks for a look into your "world of healthcare"!
Ok...so why can't Trey find a dentist who's willing to do necessary dental work?
This would be his mama....
Thanks for posting this. National health care is one of the issues I'm having trouble assessing for the upcoming election, so this is all good to know.
Hi Penni
Good question. The problem isn't finding a dentist (I think he's been to three) it's that they don't think it needs to more serious work that the US dentist did.
Jonathan says the dental work here is "fine", but he's not thrilled with it.
Good question - I hadn't considered this when writing it.
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Kari,
I hope you don't mind me putting my two cents worth on this subject on your blog.
I also am an American living in France. I also had many wonderful experiences with the French medical system while living in Paris for a year. I visited the emergency room 3 times (severe food allergy), went to my yearly medical check-ups, and got numerous prescriptions filled for various things. Everything was inexpensive compared to the US, and for the most part, I felt like I was cared for in a very efficient and professional manner.
But now I live in the French country-side....
Although the medical is still cheap and professional, it is by no means efficient or convenient. My husband needed an eye exam. After calling the 3 eye doctors that are in our area (all in towns about 45 minutes away from us), we were told that the earliest he could be seen would be in 8 months. Since this was an emergency of sorts, we paid about $200 to fly to London the next month and go to a Lenscrafters type eye doctor (these don't exist in France).
I have not been to my yearly woman's check up since we moved here because I could not find a doctor who would take me. This is because (just like eye doctors) there are too few, and there is a waiting list to get into the system. Now that I am pregnant, I will have to wait 12 weeks before I can go to my first appointment. This doctor is 45 minutes away. This is not the worst of it, the State has just closed the maternity ward and the operating services of the hospital nearest to us (45 minutes in the other direction). This now means that there are only two hospitals in our entire department (think miniature state) that have a maternity ward! These hospitals are an hour and a half away and two hours away!
I am happy to state that we still have excellent dental care out in this part of France. Each time we have made an appointment it is always scheduled for the following week. There is never any waiting in the waiting room. A cleaning (by the dentist - not his assistant) only takes 15 minutes, and all the equipment is state of the art. Even the chair looks more like a lazy-boy than a scary dentist chair! All this for only $30.
So...this is the small town France girl's view of the French healthcare system. Although my French neighbors are very mad at the State for the lack of availability of health care they receive here, the British keep moving here because the health care system in France is so much better than their socialized health care system in the UK. Talk about a disaster! Health care in the UK is awful!
Hi Rachel
Thank you leaving telling us about your experiences. The more people we hear from, the better picture we can get of what it's actually like for most people. We can pretty much only base our opinions on our personal experiences, or at best from other expats in Lyon, so I really appreciated your comment.
- K
Good post Kari, and very interesting. We've had some good experiences here and some really horrible experiences. I'm not in favor of it here in the UK- but with some changes I think it could be a good thing. I really can't get started on this b/c I will go on and on and on....
Very interesting. I'm not sure whether I support a socialized system in the US, but some of sort of reform is definitely needed. At the rate prices are going up, people will soon need loans and "scholarships" for health care like they do for college tuition.
Hi there,
Just reading your blog for the first time and really liked this article... I don't know if it's pertinent, but it's also good to point out... I am an American expat/French resident of two years.. married to a French cit. Just wanted to add to the scheme of things that if you are working and have a mutual (health insurance package) or a private one not through work (that you have to pay for yourself).. The reimbursements could get you everything back that you paid during your visits and for meds.. Depending if they are reimbursable prescriptions.... I want to say that the system is GREAT here... I live in the banlieu of Paris (Antony) and all of my doctors are in town and within short walking distance... So is the private hospital of Antony where I have tests done... All of my doctors are really nice and I cannot imagine that things are as easy in the U.S. for a lot of people.. In the U.S. I worked as a teacher for San Diego Unified School District and had EXCELLENT health care- some really good docs, others not.. but it's MUCH quicker to get an appt. here than it was in San Diego... Plus, in the U.S. I have dealt with some VERY VERY VERY imcompetent doctors.. but that could be anywhere... Take care!
kari,
for 2007, the U.S. govt. ran a deficit of over $500 billion, the Bush administration did not include certain military funding in their deficit projections. The War on Terror has cost hundreds of billions. Per capita, what does a deficit of $11 billion amount to for French citizens? The $460 billion military expenditure by the U.S. last year equals roughly $1,500 per U.S citizen. Ironically, that was also the cost of the one MRI I had on my shoulder last week. The cost of a prescription for 60 mild pain pills was $159 - a month's supply.
The "War on Terror" should be waged against run away capitalistic greed and the political system that has sold out the future and freedom of my grandchildren.
Love, PAPA
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