mercredi 30 mai 2012

French Health Care

The French national health system, la sécurité sociale, is often cited as one of the best in the world. It served as a model for ObamaCare and Michael Moore gives it ample laudatory footage in his 2007 film “Sicko”. But as with any industry where humans are involved, there is good and there is the not-so-good. And then there is the downright ridiculous, which I wrote about in the Papaya Cure.

As a longtime beneficiary of the health system here I’ve had lots of opportunities to observe and experience some of the terrific--as well as odd--services that make the French national health system one of the most talked-about when we talk about healthcare.

The Good and the Enviable: Cost

 “In France, you pay into the system according to your means. And you take out of the system according to your illness.”

I’m misquoting Karl Marx here, but this is the core philosophy upon which the French system is constructed. Outsiders often think that the French system of socialized medicine is free. Guide books will tell you that should you take ill while vacationing in France, you can walk into any emergency room and be treated “without paying a dime!”. But the reality is that it’s not free—we are taxed heavily (I pay 60% of my gross salary back to the government and they disburse it to several agencies, the healthcare system being but one of them). In that way, paying taxes is a bit like paying an obligatory insurance policy. If you have children, get sick a lot (or have children who get sick a lot), live to be old (and get sick a lot), you’ll be very happy that you and your fellow citizens paid all those taxes all those years. On the other hand if you are childless, in excellent health and age without incident, you’ll never get your money back out of the system. But you are helping the Community (which is, after all, one of the tenets of the French Republic) so that alone will get you in to heaven. (And with that sentence, I just violated another tenet of the French Republic, which is to never mix the sacred and the secular.)

I’ve already amortized my investment. Between birthing one baby on French soil and having a serious accident with a resulting year of physiotherapy, I’d say the French have put about 1.5 million dollars in me at this point. So you’ll never hear me complaining about the system here, unless it’s about the hospital food.

The less-than-stellar and sometimes irritating: Lack of centralized information

Every French parent knows the “Carnet de Santé.” This booklet is given at birth—one for each child—and you take it with you each time you bring your child to the doctor. Some are plain (my daughter who was born in America has a boring white one, given to us by the French consulate in San Francisco), some are fancy (her sister, born in Neuilly, has one whose cover features a sketch of a child going through her developmental stages), and there is an entire industry devoted to making cute protective covers for them. (Not included in your national health plan.) The carnet de santé is sacred.  You must not lose it, for inside is your child’s health history: vaccinations, milestones reached, height, weight, all illness ranging from the common cold to the more-serious. French people like to visit lots of different doctors, often for the same malady, so the carnet de santé is a sort of ambulatory health file. The doctors don’t keep centralized files on you. You do. For adults, this means you keep all your xrays, blood test results, MRI records…all the data you’ve obtained from the different places you’ve been treated. If you are sick a lot, you’d better have a closet dedicated to holding all your different films and paperwork, which you’ll have to carry with you each time you see a doctor.

Another problem with such disparate information is that the doctors in France only know their area of expertise. You cannot ask, say, your orthopedic surgeon, for a referral to a good physiotherapist. A surgeon only knows how to operate. He is not tied in to a larger community of healthcare providers. This is quite different from the States, where all these guys get together at lavish conferences in Hawaii and try to create lucrative networks. I speculate that the isolated nature of healthcare professionals in France may be a result of the lack of impetus in profit-making.

The usually kooky and often ridiculous: Medicine Douce, or alternative treatments

Homeopathic or “kooky” medicine is practiced right alongside allopathic, or “western” medicine in France. You could go to a dermotologist with a hideous rash all over your body and get prescibed cortisone-- a legitimate drug (‘take one every morning”) as well as apis mellifica, a voodoo treatment (“place five granules under your tongue every three hours”). The “real” medication will come in some boring vial or box whereas the “fake” medicine will have some elaborate system of delivery and some extremeley intricate and impossible-to-comply-with method for application. That is so that when the worthless sugar pill fails to live up to its promise, the fault is yours. I was recently told, when I purchased some snail slime, that I “should use it for two weeks. If you don’t see results, it means your body is not receptive to the product.” That makes sense. It’s my body that is not receptive, and not your product which is completely bogus. (I bought it anyway. And no, it did not work.)

Hopefully we will all enjoy good health and limited contact with any health care system, French or not. But if you do find yourself in a French doctor’s office, it’s important to keep your mind open and your mouth shut. The latter I learned first hand when one of my doctors brought out some medieval-looking hook which he wanted to use on me to break up some scar tissue. Fearing leeches next, I exited his office as fast as possible.

4 commentaires:

  1. I think all systems of socialized care have their limits and problems and the primary one is that many people will pay in more than the services they receive are worth. That being said, the same applies to private insurance. There are always people who disproportionately use the system and those who don't use it at all.

    The main problem is the people who use the system indiscriminately for small problems that really don't require medical attention. In the country I used to live in in Asia, old folks were notorious for visiting the doctor regularly for attention rather than because they were actually in need of care. They did this because, past a certain age, care was free (whereas at other ages, they have to pay 30% or 10%).

    Given the way care is distributed in America, on balance, I think it's better to have a socialized medical care system. There are flaws in every system and one in which everyone gets lesser care with some difficult is better than one in which some people get no care while others get great care. My sister's situation with cancer certainly brought that home. She is going to go into great medical debt because she had no health insurance through her work and that wouldn't happen in a country with socialized medicine.

    1. The main problem is the people who use the system indiscriminately for small problems that really don't require medical attention

      This is one of the reasons the FNH boasts such an impressive deficit. The other is that doctors never leave a doctor consultation without a prescription for at least six medications, most of which can be bought OTC. But if the doctor prescribes them, they are "free" so the French prefer to visit the doctor to save a couple of euros on the tylenol or whatever. I've always found this odd, although I guess when you are 70 you have more time to spend going to see various practioners.

  2. The same situation with medicine being over-prescribed and cheaper or free from the doctor happens in the country I lived in as well! This would seem easy to fix, yet it continues.

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