French Healthcare

1. French Healthcare By Nick Kurek Greg Vander Ploeg

2. USA vs. France

3. Why is the French healthcare system rated first? • The French are focused on preventative care to lower costs. • Everyone has health insurance. • Insurance usually covers 70 – 80%. • The sicker you are in France, the more coverage you get. • 24 hour Access – can go to any doctor or hospital and they have same day appointments (even dentists). • Doctors make house calls. • Mandatory health check ups for children. • Kids aren’t allowed to bring lunches to school. School cafeterias provide nutritious foods for students.

4. Reduced Stress = Better Health • 35 hour work week (some work 39 but get a bonus 4 hours of vacation per week) • 5 weeks paid vacation/year plus sick days, which aren’t counted as vacation days. • 11 National holidays • Not burdened by healthcare costs • Funding for raising children • Wine

5. Publicly Financed Health Care • The public health insurance scheme accounted for 76.6% of total health expenditure in 2008. • The public health insurance scheme is financed by employer and employee payroll taxes (43%), • income tax (33%), created in 1990 to broaden the revenue base for social security; • Revenue from taxes levied on tobacco and alcohol (8%); state subsidies (2%); and transfers from other branches of social security (8%). • There is no ceiling on employer (12.8%) and employee (0.75%) contributions, which are collected by a national social security agency. • Coverage for those not eligible for the public scheme or complementary private coverage is mainly financed by the state through an earmarked tax on tobacco and alcohol and a 5.9 percent tax on the revenue of complementary private health insurers.

6. CouvertureMaladieUniverselle(CMU) • Allows any person lawfully residing in France for over three months to receive this free health insurance. • Supplementary CMU allows access to care for people with low incomes and living in France. Healthcare costs will be covered 100% with no upfront fees, including the portion not reimbursed by social security and hospital daily fee. In addition, you will not have to pay the flat fees. • Illegal aliens are entitled to heath care via the Aide médicale d'Etat (AME, State medical aid).

7. Coordinated Care Pathway • A part of CMS is that you must choose a primary doctor to see first or else you lose some reimbursement. • This doctor will do the following: • coordinates your care for optimal healthcare • Ensures preventative care • Directs care to specialists • Knows and manages your medical record • You may see except a gynecologist, ophthalmologist and dentist without your doctor’s referral . • You are allowed to change your doctor at anytime you just have to report it

8. Medical Costs • The French people do have to pay some of the medical costs (besides taxes) but at really low rates • 80% have private health insurance that cover some of these costs. • Exempt: • Children under 18 years old. • women supported through pregnancy (required exams and the exemption period of the first day of sixth month of pregnancy on day 12 after birth). • If you are on the universal health insurance supplemental plan (CMU-C) or medical assistance from the State (MEAs)

9. Co-payments • The co-payment is the portion of health spending, which remains at your expense after reimbursement of health insurance. It applies to all care and medical expenses reimbursed, whether it be a consultation with a doctor, a purchase of prescription medications, etc.. • Example: Seeing a doctor has a repayment rate of 70%. • GP rate is € 23 • You pay € 7.90 • Specialists range from € 25- € 37 • You pay € 8.50 - € 12.10

10. Medical Deductible Fee • The medical deductible is an amount that is deducted from the reimbursements made by your health insurance on drugs, paramedics and medical transportation. • The deductible amount is: • 0.50 per box of medicine (or any other package: bottle for example); • 0.50 per paramedical act; • 2 euros a medical transport. • Maximum limits • You can only be charged 2 euros per day on paramedical acts. • You can only be charged 4 euros per day for medical transports. • You can only be charged 50 euros per year for any of the above.

11. 1 Euro Flat Fee • To help preserve the French health care system, a flat fee of 1 euro is charged for • all consultations and procedures performed by a physician • Radiology scans • Lab tests. • Limits • You can only be charged 4 euros/day per physician • You can only be charged 50 euros/year • This fee isn’t assessed • At the dentist. • Care performed by a midwife. • Care performed by a nurse, a physiotherapist, or speech therapist. • As part of surgery, hospitalization of one or more full days in hospital. • For acts performed as part of a screening for breast cancer.

12. 18 Euro Flat Fee • The flat fee of 18 euros applies: • Acts to which the bill is greater than or equal to 120 euros, whether performed in the office of town, in a health center, or in a health facility (hospital, clinic) as part of outpatient visits. • Expense of hospitalization in a health facility (hospital, clinic), including hospital at home (HAH), during which an act is performed with a therapeutic or diagnostic rate is greater than or equal to 120 euros. • Examples • If you have one or several procedures done and the bill is over 120 Euros the 18 Euro flat fee is applied • The 18 Euro flat fee is only applies once during a hospital stay no matter how many procedures you have.

13. Hospital Stays • Apart from cases of emergency hospitalization, you can seek treatment in the hospital of your choice, both public and private. • If you are hospitalized in a public or a private hospital, Health Insurance reimburses your hospitalization 80% • The Health Insurance also supports some of the treatments performed before or after hospitalization. For example, you will be reimbursed 70% for a consultation with an anesthesiologist before surgery, and 60% if you need rehabilitation sessions after surgery. • During hospitalization, the fixed daily hospital charge participates in the hospital and applies to all. It is due for stays longer than 24 hours in a health facility. However, some reasons for hospitalization may be exempt. • 18 euros per day in a hospital or clinic; • 13.50 euros per day in the psychiatric ward of a health facility.

14. Hospital Stay (continued) • Your hospital expenses will be fully refunded if you are in the following situations: • you are hospitalized more than thirty consecutive days (your support begins at 100% on the thirty-first day); • you are pregnant and need to be hospitalized for the last four months of your pregnancy, your delivery, or for twelve days after delivery; • for your newborn, if hospitalized within thirty days of birth; • you are hospitalized because of an accident or an occupational disease; • you are hospitalized due to long-term illness; • for your minor child, if hospitalized due to sexual abuse; • you receive a pension for accidents at work (with a disability rating at or above 66.66%). Your beneficiaries also benefit from this support to 100%; • you hold a disability pension, a pension of disabled widow or widower, a pension that replaced your old age disability pension, or a military pension; • you are covered for Alsace-Moselle; • you get the universal health insurance or medical assistance from the state.

15. Hospital Spending per Discharge, 2009Adjusted for Differences in Cost of Living Dollars * 2008. ** 2007. Source: OECD Health Data 2011 (June 2011).

16. Long Term Illnesses • Long term illnesses are covered 100% by health insurance (surgeries, drugs therapies, ect…) • Examples • Cancer (every cancer patient can get any drug, including the most expensive and even experimental ones) • Multiple sclerosis • Diabetes • Alzheimer's • Psychiatric disorders

17. Pregnancy/Childcare in France • Maternity stays for a normal delivery are a minimum of five days • Mothers are required to take a minimum eight weeks' maternity leave, but are entitled to a total 16 weeks (usually six weeks prior to the expected date of delivery and ten weeks after). • Two additional weeks prior to delivery may be awarded in the case of a pregnancy with complications. • For a third child, leave is extended to 26 weeks (eight pre-natal and 18 post-natal). • Mothers expecting twins or triplets (or more) are entitled to 12 - 24 weeks' pre-natal leave, and 22 weeks of post-natal benefits. • The Husband gets 11 consecutive days, or 18 consecutive days in the case of a multiple birth. • Adoption leave is ten weeks, or 22 weeks for the adoption of more than one child. If the adopted child is at least the third child in the household, the leave period is extended to 18 weeks. • During maternity/ paternity leave you are paid 100% of your salary. • There are several family benefits. Depending on income, you get a certain amount of money for giving birth/adopting, day care, school, and get monthly payments until your child is 20.

18. SAMU (equivalent to 911) • The French approach is to treat the emergency on-site and vehicles and personnel are equipped and trained for this. The reason is that recovery rates are found to be much higher when a victim is treated as soon as possible. • Ambulances have a two tier system • Basic EMS run by the fire department • MICU have a Physician, nurse and EMT on board. These are run by the hospital.

19. SAMU (continued) • When you call SAMU they: • analyzing calls on patient need • The physician at the SAMU site decides the best solution for the patient's care • dispatching the most appropriate mobile care resource (MICU, Ambulance, or Mobile care professional), or • directing the patient to an alternative fixed resource such as primary care medical surgery or hospital service, or • offering care advice over the telephone • The outcome of this SAMU call center by choosing the appropriate solution is : • improving the care of patients in live-threatening conditions • avoiding useless medical procedures • avoiding unnecessary hospitalizations • ensuring and simplifying the access to G.P. on duty • monitoring emergency procedures • preparing the reception of the patient at a suitable hospital. • Because of this aggressive triage, calls result in: • 30% get information/advice over the phone • 30% send a GP on duty to the site • 30% send ambulance • 10% send mobile intensive care units (MICU)

20. Doctors • Get paid a lot less than what U.S. doctors get paid but they get: • Free medical school • Low taxes • Low malpractice rates • Every patient has insurance

21. Physician Incomes, 2008Adjusted for Differences in Cost of Living Dollars Orthopedic surgeons Primary care doctors Source: M. J. Laugesenand S. A. Glied, “Higher Fees Paid to U.S. Physicians Drive Higher Spending for Physician Services Compared to Other Countries,” Health Affairs,Sept. 2011 30(9):1647–56.

22. Quiz – True or False • France has a better healthcare system than the U.S. • French doctors make house calls. • Reduced stress = better health. • Wine is good. • SAMU is the French equivalent to 911. • Doctors in France get paid less than in the U.S. • In France long term illness is 100% covered by insurance.

23. References • http://www.who.int/en/ • http://www.globalhealthfacts.org • http://www.commonwealthfund.org • http://www.businessweek.com • http://www.cleiss.fr • http://www.ameli.fr • http://www.samu-de-france.fr/en • http://www.kaiseredu.org • http://www.understandfrance.org • http://www.google.images