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Comments from France on the 2013 Commonwealth Fund Survey

Comments from France on the 2013 Commonwealth Fund Survey. Pr Isabelle Durand-Zaleski. Key findings. High population coverage by statutory health insurance Average: Spending Access Waiting times High complexity and costs of supplemental health insurance. The four paradoxes.

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Comments from France on the 2013 Commonwealth Fund Survey

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  1. Comments from France on the 2013 Commonwealth Fund Survey Pr Isabelle Durand-Zaleski

  2. Key findings • High population coverage by statutory health insurance • Average: • Spending • Access • Waiting times • High complexity and costs of supplemental health insurance

  3. The four paradoxes • Every person is covered but not for 100% of their expenditures • Single payer system for the statutory health insurance (SHI) but huge complexity for voluntary health insurance (VHI) • Free choice of physician, but dissatisfaction with access • Expensive for the payer but 2nd worst in financial access to care

  4. Coverage • Good for hospital care • Medium for out of hospital with incentives to use gatekeeper and to use generics • Very poor for eye and dental care

  5. Complexity • SHI: ensure that entitlement is recognized • For means-tested government sponsored supplemental insurance, about 50% of the eligible population has registered • For employer-sponsored or self paid VHI: complex, opaque (Le Monde survey) with hidden costs

  6. Choice and dissatisfaction with the system • Patients want to choose their physician, not their insurer (evidence from the government-sponsored program) • Dissatisfaction with access: • Télémédicine experiments

  7. Expensive for the payer but 2nd worst in financial access • Extra billing: 2013 agreement to limit extra billing to 150% of the official tariff eg 70€ for a specialist visit • Direct third-party payment from SHI to physicians (resisted by physicians’ unions) • Suggested reforms (not implemented): • Out of pocket payments based on income • Free hospital care

  8. National strategy 2014 • Increase generic use • Reduce medication volume • Control medication costs • Fight against fraud and abuse

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