When Americans think of healthcare systems in other developed countries, the first ones that come to their minds are the Canadian and British healthcare systems. One system that is typically overlooked and that is actually much closer to our system is the French healthcare system.

The most notable feature of the French system is that while it does not rely on a single-payer system, it provides universal coverage for 100% of the population. It is the concept of solidarity that guarantees financial protection when people get sick. Basically, the system is a mixture of public and private insurance with unlimited choices and little-to-no wait lists. The national insurance program covers 70% of medical bills. The rest is covered by private health insurance that is employer-based and affordable.

Let’s take a deeper look at how les francais do it. In a previous post, I assessed the US healthcare system on three main dimensions: cost, quality and access. I will use this same approach with the French system.

Cost

The French spend about 11% of their GDP on healthcare, which translates into $3,374 per person per year. Clearly, it is a very expensive system. But it is not the most expensive in the world as that honor is reserved to our system. In fact, France ranks 7th among all industrialized countries in terms of high costs.

That is not to say that the French government is not concerned about costs, as it is continuously considering ways to reduce expenses. The main reason for these relatively high costs is overuse. Since the French pay no deductibles and low out-of-pocket expenses, they tend to seek healthcare services that are not necessarily needed. For example, they visit their doctors about twice as often as Americans, they overuse their emergency rooms, and they lead the world in drug consumption.

Quality

In a 2008 study comparing 19 industrialized countries on “amenable mortality,” a measure of deaths that could have been prevented with good healthcare, France came in first (meaning it had the lowest mortality rate). The US ranked 19th and last.

In an older study ranking all countries on healthcare system efficiency (how effectively governments spend their money on health, how well the public health system prevents illness and how fairly the poor are treated), France came first among 191 countries (the US came 37th). Part of the reason for these exceptional results is great pre-natal and post-natal care, strong cancer case management, and access to all cancer drugs including the most expensive and even experimental ones.

Access

Every legal resident in France has access to healthcare. As previously mentioned, the majority of people have 70% of their coverage paid by public plans and therefore have to purchase employer-based private insurance to cover the rest. However, two special groups receive special treatment and are 100% covered by public insurance: the very poor and the very sick. Legal residents who earn less than a certain amount are entitled to 100% reimbursement for doctor and hospital costs. Similarly, people that have one of 30 chronic conditions (such as diabetes, cancer and mental illness) have all of their healthcare bills picked up by the government. Now that is solidarity!