Access to Healthcare in France - Research Paper Example

Access to Healthcare in France number: Number Number Introduction France is a diverse country with a large population and a higher percentage of life expectancy. Health is a public issue in France and considered “an inherent individual right,” dating back to the French revolution and “the Declaration of the ‘Droits de l’Homme’” (Sargent & Larchanché, 2008, p. 3). France’s health expenditures in 2000 amounted to 9.5% of its gross domestic product (GDP), which was a bit lower than that of the United States (Latry et al., 2010, p. 743). The French healthcare system is government funded operating under a national-health insurance system that reimburses health services for the entire population. The government through the Ministry of Health, the Ministry of Social Security and several other government agencies manage the insurance scheme; it is a combination of a national insurance recognized and managed by the state and financed by the employer and employee tax contributions. The employees are affiliated from three insurance schemes but all members of the population are covered systematically (Latry et al., 2010, p. 743), prompting the World Health Organization to recognize the French healthcare system as the world’s best in year 2000. Hypothesis The French healthcare system has been effective in providing the necessary healthcare for most of its citizens but the health services provided by the system need review and limitations so that the costs could be covered by government funds. Policies in place The French health care system is known as the General Scheme which provides the Social Security, and is a mix of universal ideals and the French cultural values of “solidarity and fairness” (Roth, 2010, p. 330). It is a public-private collaboration of hospital and ambulatory care, reinforced by higher resources of care and services. The General Scheme encompassed other areas of health, such as the health insurance component. The latest step of this system was the Universal Medical Coverage (Couverture médicale universelle: CMU) which took effect in 2000. The current health insurance scheme encompasses about 80% of the French population, including illegal immigrants. Also covered are the individuals from special groups, like miners, seamen, and railroad laborers, who protested for additional benefits a few years back (Roth, 2010, p. 330). The history of the French healthcare system goes all the way back to 1945 with the creation of the Social Security System, Securite Sociale, whose power and responsibilities encompassed management of funds for medical care, including retirement benefits, family allowances, disability allowances, workers’ compensation and occupation diseases. This was a general scheme founded on the principle of solidarity that guarantees every French citizen “financial protection against life’s uncertainties” (Roth, 2010, p. 329). This was the basis for the universal declaration of human right and assuring society’s responsibility to all members or to the entire population. Over the years, the General Scheme became the milestone for Social Security, strengthened and popularized to include more classes of the population. It encompasses health insurance, occupational accidents and diseases, old age issues, and family benefits. The majority of the French population has been supportive of the healthcare system and their quality of life and overall patient satisfaction have increased (Roth, 2010). A number of changes and modifications have been in place since then with the WHO announcement that it is the best healthcare system in the world (Sargent & Larchanché, 2008, p. 3). Structure of the system The main parameters of the current health care system were provided in place during the period from 1945 to 1950, with the reformatting of the national health insurance. But after the war, a new law expanded the social security system in three dimensions: “retirement, family allowances, and sickness” (Rochaix and Wilsford, 2008, p. 99). Policies were then made aligning the provisions on those three dimensions or parts. The French healthcare system is now known as the Caisse Nationale de l’Assurance Maladie des Travailleurs Salariés (Cnam-TS), which is believed unique in the world and even surpasses that of the United States’ healthcare system known as the ObamaCare. It also has a unique way of reimbursement scheme, covering reimbursement of patients’ expenditures including spa expenses. The French government believes that spa is preventive care. The reimbursement scheme uses a centralized database termed “Erasme,” which provides annual report from its database of reimbursed drugs purchased from community drugstores (Latry et al., 2010, p. 744). France permits a monopoly of pharmaceuticals allowing drugs to be purchased at communities and hospitals. Medicines delivered to pharmacies are either prescribed or non-prescribed or over-the-counter drugs (Latry et al., p. 745). The structure The hospital system is comprised of the public hospitals (65 percent of beds), private not-for-profit hospitals, those managed by religious organizations (15 percent of beds), and private hospitals (20 percent of beds). Securite Sociale has provided funds for public and private not-for-profit hospitals, based on the hospitals’ reported annual budget. Private for-profit hospitals receive payment from individual patients depending on the medical services provided. These hospitals are also divided into: acute care hospitals, rehabilitation hospitals, and long-term-care hospitals. The government reimburses payment for long-term-care but the patient has to pay the room charges. Ninety percent of hospitalization costs are covered. If the patient does not have the amount to pay, relatives can help; otherwise, the community aid from taxe d’habitation, a local tax collection, provides assistance on installment basis. From the private sector emerged the Healthcare Networks which became popular in France when AIDS emerged as one of the dreaded diseases. Healthcare Networks emphasize palliative care using a multi-task approach to healthcare, such as “medical, social and psychological care” (Plu et al., 2007, p. 55). For ambulatory care, patients have the chance to choose their physician with full freedom and they could even change as often as they want, or look for other general practitioners or specialists. Reimbursements are quite generous and cover payment for physician fees and other expenses for laboratory tests. They physician is also free to prescribe any medicine that he/she feels suitable to the sickness. The fee levels are regulated depending on the agreements that physician unions negotiate with the funds (Rochaix and Wilsford, 2010). Outcome of the current system The French healthcare system is known to be generous to the entire population, but it is not without faults. Services covered are not covered in other countries, for example, services for spa which French politicians say it is covered to prevent sickness. The government is now going to assess the current system since funds are becoming depleted for reimbursements. Policymakers do not know how much money from the national budget can be provided for the reimbursements and how much do insurance companies have to shoulder. Roth (2010) asks if France should spend more for national defense or healthcare system. But the rest of European countries prefer the healthcare system; that is why the French system is envied by other European countries. Health outcome indicators Health outcome indicators are high and the expenditures with respect to the gross domestic product are far lower than in the United States. The French people are satisfied as they have a choice of insurance providers. Patients are now taking an active role in the management of their healthcare and they want to be informed of their status as patients. A qualitative study was conducted on French users of the healthcare system (Chalamon, Chouk, & Heilbrunn, 2013). The participants were aged 21 to 76, recruited using several methods and were interviewed in their home or in a private office in Paris and Lyon. The aim of the study was to determine the patients’ expectations towards the French healthcare system and the services provided by the health professionals. There were negative points brought out by the participants and one of these is the aspect of communication to respond to the patient’s expectations. The participants noted that in order to have a satisfying communication between patients and doctors, the latter should consider the content of the information and the way medical information is given. This is needed in the patient profile. The study was conducted in the French context because the researchers noted the effectiveness and uniqueness of the French healthcare system. As a whole, the participants were satisfied of the healthcare system (Chalamon et al., 2013). Has the country tried something to improve the system? What is the impact? France has a high leverage for reform considering that the economic pressures are bearing down on the policy makers. The problem is cost containment and the leaders are reviewing the details of the law enabling the French healthcare system to provide a comprehensive health care for all of its citizens. In health care, an effective policy ensures a relatively high access and a fairly comprehensive coverage without “breaking the bank”. Rochaix and Wilsford (2008) indicated that covering the costs of the healthcare system have failed although there are moves to accumulate the costs. One reform that was made was to provide financial access for the very poor by way of introducing the universal medical coverage known as the Couverture Maladie Universelle (CMU) (Rochaix and Wilsford, 2008). Another move enabled the replacement of the employer-employee payroll taxes with a new tax known as Contribution Sociale Géneralisée (CSG). But these reforms provided equity and efficiency outcomes which needed more analysis for policy makers. The study of Rochaix and Wilsford (2008) focused on an analysis of the state’s performance in addressing the costs. The solution might be to limit the services that can be reimbursed. References Chalamon, I., Chouk, I., & Heilbrunn, B. (2013). Does the patient really act like a supermarket shopper? Proposal of a typology of patients’ expectations towards the healthcare system. International Journal of Healthcare management, 6(3), 142-151. doi: 10.1179/2047971913Y.0000000036 Latry, P., Molimard, M., Bégaud, B., & Martin-Latry, K. (2010). How reimbursement databases can be used to support drug utilization studies: example using the main French national health insurance system database. European Journal of Clinical Pharmacology, 66, 743-748. doi: 10.1007/s00228-010-0819-0 Plu, I., Moutel, G., Purssell-Francois, I., Lapidus, P. Ellien, F., Manaouil, C., & Hervé, C. (2007). Ethical issues arising from the requirement to provide written information in palliative care. Palliative Medicine, 21, 55-57. doi: 10.1177/0269216306073699 Roth, M. (2010). “Liberty, solidarity, fairness”: A personal view of the French healthcare system. Cambridge Quarterly of Healthcare Ethics, 19(03), 329-333. doi: 10.1017/S0963180110000101 Rochaix, L. & Wilsford, D. (2008). State autonomy, policy paralysis: Paradoxes of institutions and culture in the French health care system. Journal of Health Politics, Policy and Law, 30(1-2), 97-119. doi: 10.1215/03616878-30-1-2-97 Sargent, C. & Larchanché, S. (2009). The construction of “cultural difference’ and its therapeutic significance in immigrant mental health services in France. Cultural Medical Psychiatry, 33, 2-20. doi: 10.1007/s11013-008-9115-1 Read More