Why The French Can Afford To Get Sick

A doctor in Paris
A doctor in Paris

"A votre sante" ... "To your health" … say the French as they raise a glass in toast. The French do take health care seriously, and provide it in a system quite different from our own. Our Man in Paris, David Turecamo, offers his take on the French model:

This summer in Paris my friends Matt and Noemi had twins. Matt's British so they ended up naming their sons George and Alistair. But Noemi's French - and that's what's important here, because the entire family is covered by the French Social Security system.

So, even though the boys were delivered by Cesarean section and Noemi spent nine days in a private room, after leaving the hospital they paid …

"19 euros, for the TV," Matt said.

That's around twenty-five dollars.

Well, they also paid a $165 for the first night, but for twins delivered by Cesarean, and nine days in a private room, and the cost was about $190?

Maybe we could learn anything from it.

"All the people coming to our emergency department are treated equal," a doctor told Turecamo. "We can't say to a patient, 'Oh, you don't have money or the right kind of insurance.'"

In fairness, emergency rooms in the United States are obliged to treat and at least stabilize everyone - but because of the cost many Americans never see a doctor until it's an emergency.

If anything the French go to doctors too much simply because they can afford it. You see, a typical office visit will cost them 22 euros. That's about $28.

"Obviously that would make an American laugh," the doctor said.

But don't laugh - 65% is covered by the national health system. The rest is picked up by private insurance which is available to everyone at a nominal cost. But even with that, one doctor in private practice told me, "If a patient has a big problem - no job, nothing - I say 'Okay - don't pay.'"

You should know French doctors make a lot less than their American counterparts - roughly $50,000 to $100,000 a year - because the French government (not doctors or pharmaceutical companies) sets the prices for everything - prices they feel are reasonable.

While critics argue that's socialized medicine, some doctors argue it's what we call managed care.

"Most of the time it doesn't cost anything for the patient," said the doctor.

So the French go to a drug store to fill a prescription and most people don't pay anything.

Sound good?

Well, eight years ago the World Health Organization released a study ranking France as having the best health care system in the world.

"Well, even the French tend to roll their eyes when they hear that," David said, "and the study itself has been criticized for its methodology.

"But it's not just the quality of health care this country offers, it's the fact that it's offered to everyone. Every man, woman and child who is a legal resident in France is covered by national health care."

It's a comprehensive system that's innovative as well. When you call the emergency number (SAMU is like our EMS, or emergency medical services), first you talk to a doctor ...

"Oui, bonjour c'est le docteur du samu."

… who decides whether or not your case is an emergency. It's a time- and cost-effective measure because out of every thousand calls they receive, only about fifty turn about to be real medical emergencies.

"That means in more than 95% of the case we can deal with the call without using the full team," the SAMU medical chief said.

Because the full SAMU team in France includes a doctor, nurse, technicians and a battery of equipment and drugs, including drugs you will not see in an American ambulance. "These are drugs for general anesthesia," the SAMu staffer said. "We have all the monitoring; we have the possibility to give the drugs with infusion with a computer. It's like having a small part of the emergency room in the street."

See, in the U.S. ambulance teams are paramedics whose job is to get a patient to the nearest hospital quickly. Here the idea is to bypass the emergency room altogether. The patient is treated at the scene (on average for about 45 minutes), and when she is moved to a hospital it's one chosen not for its proximity but for its specialty

"We think this hospital is the better place for this type of disease," the SAMU doctor said.

Because treatment has already begun, the patient is taken directly to the specialized ward where the specialist is waiting for her.

Are there failures? Of course … case in point: the death of Princess Diana, which some say was caused because SAMU spent more than an hour and a half treating her at the scene before moving her to a hospital.

But overall, doctors agree the system is pretty effective.

"If you have some paramedics that is allowed to do some procedures that's good," SAMU medical chief said. "But where is the diagnosis? To go in the hospital and to save time we need a precise diagnosis."

But what if it's not an emergency? What if it's, like, well, during this January blizzard a few years back, my daughter ran a fever and …

Look, every doctor makes house calls, but this group, SOS Medecins, specializes in making house calls at off-hours and weekends

They respond to about 2 million calls a year across France and can have a doctor at your home or hotel generally within an hour of your call.

They receive no state support and charge 52 euros, or about $65 for a visit - which generally is fully reimbursable.

Of course, all this comes with a price tag.

On a per capita basis it costs the French about $3,400 a year for health care, most of which, they complain, comes from taxes.

But in the U.S., per capita spending for health care is almost double that figure

And there are still roughly forty six million Americans who are uninsured.

And while the French are determined to preserve their system (it's currently running a 12 to 14 billion dollar deficit), most agree something's got to change.

"People come to France just to have free care and they don't pay," one doctor said.

So, is their system really better than ours?

Well, the only thing I can really say definitively is, in France you can go to the hospital without going broke.