tag:blogger.com,1999:blog-2424131704277823220.post4765288877341487597..comments2023-09-23T11:16:00.352+02:00Comments on The Franco-American Flophouse has moved: French and American Healthcare - Not So Different After AllVictoria FERAUGEhttp://www.blogger.com/profile/16319699673885400472noreply@blogger.comBlogger22125tag:blogger.com,1999:blog-2424131704277823220.post-82899197975240425382015-01-13T05:36:39.313+01:002015-01-13T05:36:39.313+01:00This comment has been removed by a blog administrator.Legal Puffshttps://www.blogger.com/profile/08345893862517923167noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-78673207456379837092015-01-13T05:36:38.315+01:002015-01-13T05:36:38.315+01:00This comment has been removed by a blog administrator.Legal Puffshttps://www.blogger.com/profile/08345893862517923167noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-90675077343872877442014-11-04T10:57:00.326+01:002014-11-04T10:57:00.326+01:00This comment has been removed by a blog administrator.health informationhttp://healthinformationview.comnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-48602665765309294572014-04-25T11:35:05.852+02:002014-04-25T11:35:05.852+02:00Hi Steve,
Hey thank you for stopping by the Floph...Hi Steve,<br /><br />Hey thank you for stopping by the Flophouse and for the comment. Yes everyone's mileage will vary here. What's interesting is that underneath it all are common goals but different ways of getting there.<br /><br />All the best,<br /><br />VictoriaVictoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-44203882444689269102014-04-15T19:24:29.473+02:002014-04-15T19:24:29.473+02:00Wow! Such an interesting entry. The issue of a nat...Wow! Such an interesting entry. The issue of a nation’s health care system is so complex in that pros and cons would naturally be present. And since not every individual has the same health issues, some would receive a certain health care system more favorable than the others. I’m glad you were able to present both cases of the American and French health care well. Thanks for sharing!<br /><br /><a href="http://arizonahealthinsuranceexperts.com/company/" rel="nofollow">Steve Fischer</a><br />Anonymoushttps://www.blogger.com/profile/13334300027174716917noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-46103542352231655082012-07-07T07:35:49.375+02:002012-07-07T07:35:49.375+02:00Hi Anonymous, Thank you so much for your comment a...Hi Anonymous, Thank you so much for your comment and for relating your experience. Yes, French doctors do house calls which I find absolutely wonderful. It was a godsend when the Frenchlings were little. When we lived in the US our only option for an ear infection in the middle of the night was the local children's hospital. Here it was simply a matter of calling whatever local doctor was on call that night and having him/her come to the house. Just amazing. And as you so rightly mention, the price is definitely affordable.<br /><br />VictoriaVictoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-27364210063073896442012-06-14T01:33:04.248+02:002012-06-14T01:33:04.248+02:00I live in France part of the year and have been s...I live in France part of the year and have been sick twice, once in 2005 with bronchitis, and in 2006 with pneumonia. I arrived off the plane in Toulouse with the bronchitis. Came down with the pneumonia while on holiday in Nice. <br /><br />For the bronchitis I visited my local doctor in a village near my home. He examined me thoroughly, including chest xray, sputum and throat cultures - no nurse. He diagnosed me, gave me a prescription for 4 drugs, then pulled out a laminated sheet of paper that had fees on it, and pointed to 'non-resident alien- €23', AND apologized for having to charge me so much. All 4 drugs, including 2 antibiotics, came to €14. I dare say that would have cost me $300 in the US and I would have paid it all as I have high-deductible insurance for the self employed. <br /><br />In Nice I asked the front desk at my hotel how to see a doctor - "No problem, Monsieur. I will have one here within the hour." When the doctor arrived, at my room, he gave me a thorough physical, listened to my chest carefully and pronounced pneumonia, gave the front desk my prescriptions and left. My prescription arrived in less than an hour. When I checked out two days later the doctor's bill was on my facture - €100, the 3 drugs €30. I'm not sure I could even get a house call in the US, much less at such a trivial rate.<br /><br />I have a retired friend near Bordeaux who moved back to France entirely because of US health care. He sold his house in Santa Fe, bought a condo near his family and moved last year. I had dinner with him and his wife a few weeks ago, and he told me that he and his wife had always assumed they would return to France after retirement - because of superior health care. They are about 80, so they waited. Still... Just saying.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-92061771308896457822012-05-28T08:19:12.482+02:002012-05-28T08:19:12.482+02:00@Christophe, Thanks you so much for leaving a com...@Christophe, Thanks you so much for leaving a comment about your perspective. I really liked your point about how the doctors' offices are staffed in the U.S. I had the same experience and I also noticed that there was always at least one staff member (not a medical professional) dedicated to managing all the different insurance programs that patients were using.<br /><br />Pragmatism is in short supply these days in both countries. I think the public in both is primarily driven by fear - fear that whatever the shortcomings of the existing systems, change will only be for the worse.<br /><br />But change comes whether we like it or not because the world changes and adaptation is necessary. A friend sent me this link about a new unanticipated wrinkle in the government-managed part of the US healthcare system: veterans. They say nearly 50% of the armed services personnel coming back from Irak and Afghanistan are requesting medical care and disability for conditions related to their service. <br />http://www.foxnews.com/us/2012/05/27/ap-impact-almost-half-new-vets-seek-disability/<br /><br />VictoriaVictoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-44203536074003338662012-05-26T01:47:53.544+02:002012-05-26T01:47:53.544+02:00Here is my comment, as a French living in the US.
...Here is my comment, as a French living in the US.<br />My experience with the healthcare system in both countries is similar: luckily, I have never had to experience anything traumatic: doctor visits, tests, and a couple outpatient procedures in both countries, and the birth of my children here in the US. Like Victoria, I am very lucky to work for a company that provides great health benefits. Even if it's gotten a lot worse in the past couple years, it's still way better than most.<br /><br />I agree that the level of care is similar in both countries, both<br />excellent. Here are the points that struck me when I first moved here:<br /><br />- Cost of course: my copay ($30) is more expensive than the price of the full consultation in France. But salaries are much higher, so copays are not really a big deal.<br /><br />- Deductibles and coinsurance.<br />I only knew these notions from car insurance in France, and that shocked me that this would apply to health insurance as well. This is where it can get expensive. <br />Your insurance kicks in only after you met your deductible, which can be high (per person/per family)<br /><br />- When you go to the doctor, you spend more time with a nurse who takes your vitals and asks you about your condition than with the doctor himself. It seems inefficient to me, as the doctor could have done it himself, and a way that information could be deformed when passed from the nurse to the doctor. Some think that this way doctors can see many more patients, but I am not sure the additional number of patients really makes up for the salary of the nurse.<br /><br />- Pharmaceutical companies spending huge amount of money to advertise PRESCRIPTION ONLY drugs on TV, while still advertizing to doctors who will give you free samples of for example allergy prescription medication. I wish they would not waste all that money and accordingly reduce the price of their drugs. Some non generics antiobiotics can have a copay as high as $100!<br /><br />- Itemized hospital bills for the birth of my kids was outrageous.<br /><br />- Learning that my company was "self insured".<br /><br />- In-Network and Out of Network notion, and the difference in price between the two.<br /><br />- Learning about preexisting conditions and he impossibility for people to get insurance and care is something that is difficult to understand for people who are used to universal health care.<br /><br />- Bankrupties associated with medical costs.<br /><br />- People raising money to pay for their medical bills.<br /><br />- Life time maximums in healthcare policies.<br /><br />Would I go back to France to get care? Not if I can still get the coverage I have with my employer. But if I were to lose my job and health insurance, I will seriously consider finding a job back in France. I am too proud to beg for money to and have fundraisers to help pay for medical bills.<br /><br />Improving health care in America is a challenging issue. It is just sick that the policies are driven by who provides more money to have the politicians vote in their favor, than for the good of the American people. This nation is the one that first sent someone to the moon. I don't understand why it cannot tackle this issue/challenge from a more pragmatic way.Christophenoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-65103647621531671562012-05-23T12:20:50.356+02:002012-05-23T12:20:50.356+02:00Thanks, Kirk. Am trying to think of this as just ...Thanks, Kirk. Am trying to think of this as just another "aventure". Truth be told I'm meeting a lot of amazing people right now and I'm getting great care.<br /><br />I had heard something about the transport but haven't looked into it yet. Will do very soon. Again, thanks for mentioning it. <br /><br />VictoriaVictoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-59369998970183276302012-05-22T19:55:15.000+02:002012-05-22T19:55:15.000+02:00Sorry to hear about your illness.
One thing you ...Sorry to hear about your illness. <br /><br />One thing you might not realize, since you live near Paris, is that being on ALD also means that you get transportation paid. For me in a rural département, that means taxis when I needed physical therapy that was unavailable from my local kiné, as well as when I went to see specialists in university hospitals. I don't think insurance in the US covers this, does it?<br /><br />Aside from that, being on ALD doesn't make much of a difference. Your tests, doctors' visits and meds are covered without you having to lay out any cash, which can be helpful, but if you have a mutuelle, it generally comes out the same at the end of the month.<br /><br />I hope you're getting better. I have a friend who has leukemia right now, and he seems to be doing well. As for protocols, for diseases like that, they are the same in most parts of the world. Western medicine is pretty consistent, as all doctors generally have access to the same info and drugs.Kirknoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-5929597005223630362012-05-22T16:57:07.334+02:002012-05-22T16:57:07.334+02:00Aaron, Kirk and anonymous: Good points all. How ...Aaron, Kirk and anonymous: Good points all. How each system is actually lived by the people in is very subjective and really depends an enormous amount on personal circumstances. You might want to have a look at a blog that I follow regularly whose author is someone I've met and greatly admire. It's called Carnet de Seattle http://www.carnetsdeseattle.fr/<br /><br />Loic and his wife who are both French went to the U.S. back in 2009 for work. In March of last year he was diagnosed with leukemia. They did not return to France and he's being treated at a local Seattle hospital (same hospital where my daughter was born BTW). I'd invite you to read his posts to get a feel for how he has lived the American healthcare system. <br /><br />What is interesting is that 1 year after his diagnosis, I got my own and I'm now living a part of the French healthcare system I kinda hoped that I would never have to learn about. ALD has now become a part of my vocabulary and I'm learning firsthand how it actually works in practice (as opposed to theory). So far I'm very very pleased with the care I'm receiving here but as Loic pointed out one day, I would get (and he got) the same care in the U.S. (protocols are the same).<br /><br />So I'm going to stick with my sense that the two systems are surely different in many ways but also have some things in common. And just as Loic didn't hop on a plane for France when he was diagnosed, I'm not planning a trip back to the U.S. either. :-)<br /><br />VictoriaVictoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-25972869739629925682012-05-22T15:48:57.929+02:002012-05-22T15:48:57.929+02:00@anonymous, Thank so you so much for the such a th...@anonymous, Thank so you so much for the such a thoughtful comment. Your points are well-taken and I really appreciate your refining some of the author's arguments and evidence made in the article.<br /><br />It reminded me that there is another similarity that is not mentioned in the article but I have seen up close: the constant stream of dug company representatives passing through the offices of healthcare professionals in both countries. Some really aggressive selling on their part and I've seen piles of free samples in the homes and offices of the medical professionals I know here that were given out in the hope that they would prescribe thus and such over the competition. <br /><br />Concerning the doctors in the private sector I have a family member who was a doctor at a private clinic. It closed recently and he was officially laid off. This was a huge shock to the rest of the family who had assumed that he had more protection since he is a doctor and they thought he had a quasi-fonctionnaire status. Apparently not.Victoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-5759532018136540052012-05-22T15:15:40.407+02:002012-05-22T15:15:40.407+02:00Of course without the caveat in your first paragra...Of course without the caveat in your first paragraph, the two systems are worlds apart.<br /><br />According to a Gallup survey (here: http://www.gallup.com/poll/152162/americans-uninsured-2011.aspx) 17.7% of Americans lack health insurance and; therefore, only have access through emergency department visits. In France this would be absolutely unacceptable and despite all the systems' similarities this is too much of a difference to only casually mention.<br /><br />Then, what about health care outcomes? "It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy." (NEJM: http://www.nejm.org/doi/full/10.1056/NEJMp0910064).<br /><br />The systems may look similar, but at the moment (especially as we wait for the SCOTUS decision on the ACA) they are so very different.Aaronnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-87946287877691937112012-05-22T15:09:20.049+02:002012-05-22T15:09:20.049+02:00One other difference between the two systems: beca...One other difference between the two systems: because of caps and limits to coverage for pre-existing conditions, people can go bankrupt in the US because of medical bills. This simply doesn't happen in France. One advantage of single-payer systems is the fact that all conditions are covered, and there is no such thing as "pre-existing conditiions."Kirknoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-42168358420969100852012-05-22T14:53:43.719+02:002012-05-22T14:53:43.719+02:00Also maybe France uses also a private-public syste...Also maybe France uses also a private-public system but it should be noted that all major illness (Affections de Longue Durée) are covered 100% by the state and represents two thirds of all health spending. Maybe for minor problems there isn't lots of differences between the two systems but I'd go back to France as soon as I have the slightest hint that I need major medical intervention.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-29215552189049209332012-05-22T12:25:18.925+02:002012-05-22T12:25:18.925+02:00I have to disagree with some of what you present i...I have to disagree with some of what you present in your article. First, let me point out that I'm an American and have lived in France for 27 years. So while I'm not up-to-date on US health care, I am very familiar with the French system.<br /><br />You say:<br /><br />"59% of the doctors are private and don't work for the state in any capacity."<br /><br />While this is technically true, I recall what a physical therapist (kiné) I know once told me. He said that all health care professionals in France, unless they were working at "honoraires libres," or had chosen to set their own prices and not work with the Sécurité Sociale, were state employees indirectly. As long as you work in the system, you are a part of that system. There are very stringent requirements for how these people work if their services are going to be reimbursed. <br /><br />I think it's worth noting that the health care system is much more than just doctors; there are physical therapists, nurses, dentists, and many others.<br /><br />You say:<br /><br />"doctors expect payment up front and people are only reimbursed for the expense after the care is provided." <br /><br />This is true, but consider the cost of a visit to a GP (€23) or a specialist (generally €41). These costs are much lower than equivalent costs in the US. Yes, a minority can't afford even this, but they most likely have CMU. And the Sécurité Sociale reimburses people very quickly (though this used to not be the case). <br /><br />As for ALD - affections de longue durée, or long-term illnesses - this is not for "life-threatening illness" as you say, but long-term illnesses that will require treatment and/or tests for a long period of time. It's a good thing that this is not automatic; can you imagine the potential for abuse? Also, it is only granted for 5 years, after which it must be renewed (but the renewal process is much quicker, and does not require the same type of review). <br /><br />You are mistaken about "les partenaires sociaux;" these are not "economic actors in the private sector." These are unions, both for workers and for employers. They are a very restricted group of organizations, and the link you provide lists them. <br /><br />I think it's worth comparing prices. For example, I have to get annual MRIs for a neurological condition. People in the US with the same condition pay $2000-3000 for this (naturally, if they have insurance, they don't pay all of it). In France, this is billed at around $200. Certain medications that I've had to take can be as much as 10 times as expensive in the US; if you consider co-pays, the amount people in France pay out of pocket is much less (assuming they don't have a mutuelle). <br /><br />Finally, it's important to point out that the Sécurité Sociale covers much more than just health care. As a commenter points out, it also offers sick pay, "allocations familiales" (welfare payments to families), and retirement.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-56765271696615347002012-05-18T10:17:42.800+02:002012-05-18T10:17:42.800+02:00@Anonymous: Thank you very much for the comment an...@Anonymous: Thank you very much for the comment and for adding other similarities/differences. The article didn't really mention the "mutuelles" which is another point of convergence between the French and US systems. I can also confirm that US managed care systems do seriously limit access. Every insurance company I ever had in the U.S. had a list of approved doctors I could visit and required pre-approval for any procedure that was pricey. The medical care here is indeed excellent. One group of actors however is a big disgruntled and that is the doctors. I have 3 medical professionals in my family here (2 doctors, 1 nurse) and both doctors have considered a move to North America where they could command much higher salaries. The barrier was recertification - neither was willing to spend years studying for a license to practice in the destination country. Seems to be a bit easier in France and that may be another reason the costs here are lower: the state regulates the number of doctors trained, once trained those doctors can't necessarily leave easily to practice in other developed countries but the French state is open to bringing in foreign doctors. Needless to say, the doctors in my family found this to be an unreasonable state of affairs indeed.<br /><br />VictoriaVictoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-19771212926284042522012-05-17T21:29:58.384+02:002012-05-17T21:29:58.384+02:00Victoria
Very enlightening. I'm not very fami...Victoria<br />Very enlightening. I'm not very familiar with the USA healthcare system, but I think you could add another similarity, la mutuelle (complementary health insurance) which many employers offer in the USA and France. In France it corresponds to the difference between the amount covered by the national social see curity and actual costs. I don't know exactly how it works in the USA. <br />What is likely not similar is (1) In France, individuals with no resources benefit from "universal" health care and this may also include a "mutuelle" (CMU). (2) In France, individuals not covered by company sponsored "mutuelle" (complementary insurance) can contract for one. The cost varies depending on the type of contract chosen but would be between 50 and 100 euros per month. The cost in the USA for health insurance, so I am told, could be more than $1000 per month (3) individuals in France can freely choose their healthcare provider, I believe in the USA, the company plans provide a list of agreed practitoners. I also understand that not all treatments are covered by the US healthcare insurers. (4) many doctors in France can be consulted at either a public hospital where there are longer waiting times for an appointment but little if any payment or at their private practice at a much higher cost but which is usually covered by the "mutuelle", if you have one.<br /> (5) I am not familiar with public hospitals in the USA, but in France it is my experience that although they do not provide "hotel" type services, the medical care is excellent. Many French specialists/"professeurs" are residents in public hospitals. (6)In France, when you are absent from work due to illness, you continue to receive a portion of your salary, paid by the social security. Many employers make up the difference or it is covered by insurance. I don't know what the situation is in the USA<br /><br />I find the healthcare in France to be outstanding. Unfortunately it comes with a high price tag and there will undoubtedly come a day of reckoning.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-17556048808622478382012-05-16T10:40:43.899+02:002012-05-16T10:40:43.899+02:00@JM, yeah, I think Sicko (and anything by Moore) s...@JM, yeah, I think Sicko (and anything by Moore) should be taken with a grain of salt. The Secu and I get along just fine these days though there was some "mefiance" on their part in the beginning. The French are very sensitive these days to foreigners coming in and using the healthcare system. Alas my accent gives me away almost immediately. So I started bringing in a big file with all my bulletins de paie (15 years worth) and it hasn't been a problem since. On the contrary they have been both efficient and kind.<br /><br />@Loic, Irritating, isn't it? I've been hospitalized in both countries and frankly saw very little difference between the two. Great service, exactly the same treatments but a little less paperwork on the French side. Would have liked, however, to have had wi-fi during my hospital stay but, hey, I think it did me a world of good to disconnect for a week. :-)Victoria FERAUGEhttps://www.blogger.com/profile/16319699673885400472noreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-976319059775550592012-05-15T21:33:59.862+02:002012-05-15T21:33:59.862+02:00very good summary.
I get this question asked oft...very good summary. <br /><br />I get this question asked often a lot too and it pisses me off. <br /><br />Last time at the support group, a friend asked me about this and then proceded to tell me in great detal about the hassle of the french administration and how it was a nightmare when her sister who lives in grenoble had to be tested for a bone marrow. <br /><br />A few minutes later, another friend comments on how, (in the usa) she has been waiting for 2 weeks from the authorization from the insurrance to proceed with the transplant (which should be done has quickly has possible and from which the only alternative is death). <br /><br />I was like: "Are you kidding? And you dare pretend that this system is better?" <br /><br />It's not better, it's different. <br /><br />There is also a very annoying tendency in the US to believe that they have the best treatment and that other countries still use flint and steel. Getting them to understand that I would have had the same exact protocol in France is hard. <br /><br />Take care,CarnetsdeSeattlehttp://www.carnetsdeseattle.frnoreply@blogger.comtag:blogger.com,1999:blog-2424131704277823220.post-85943400733995572642012-05-15T16:53:07.042+02:002012-05-15T16:53:07.042+02:00Hello Victoria,
Thanks for this riveting read. In...Hello Victoria,<br /><br />Thanks for this riveting read. Indeed, I would not have thought that there are so many similarities between the two health systems, and Michael Moore's <i>"Sicko"</i> did not do much to help. <br /><br />How little I have seen of the German health system makes me sorely miss our good old <i>Sécu</i>, but well, living abroad also means making a few sacrifices.Berliniquaishttps://www.blogger.com/profile/12661821223010607978noreply@blogger.com