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Saturday, February 2, 2013

Chez les Franciscaines

In Versailles when your doctor says he is sending you "chez les Franciscaines" he isn't talking about your spiritual well-being.  He means that you are sick enough to warrant a trip to Emergency (Urgences) and the nearest one in my part of town is the local private (not public) hospital and its official name is  L’Hôpital Privé de Versailles (The Private Hospital of Versailles).  However, I have never ever heard anyone refer to it as anything other than "les Franciscaines.

The Franciscans are a Catholic religious order founded in the 13th century that follow the teachings of St. Francis of Assisi.  Under the name there are actually several sub-orders and I've never been able to get them straight (Friars Minor, Poor Clares and so on).   Sean Connery played a Franciscan monk, friar William of Baskerville, in the film based on the book by Umberto Eco, The Name of the Rose.

This private hospital had its origins in the 19th century.  It was founded by Franciscan Sisters in 1882 and was simply called "La clinique des Franciscaines."    Today it is owned by an Australian healthcare company called Ramsay Healthcare (Ramsay Santé). The Sisters (Notre Charisme de Franciscaines Missionnaires de Notre-Dame) still maintain a presence at the hospital though the Church no longer runs it.

We ended up "chez les Franciscaines" late Friday morning.  My younger Frenchling had stomach pains that look an awful lot like appendicitis to our family doctor.  So he scribbled off a note that began with "Chers amis" (Dear Friends), called us a taxi, and sent us off to the Emergency.  And if that's not enough to make you think he's a prince among men, would you believe he makes house calls too?

We arrived around 11 AM and before we know it we had a room, my daughter had a drip in and we were off to get a scan (echographie).  That and the blood test revealed nothing wrong and we were let go with a prescription for various medications that will relieve her symptoms.  The medical team was incredibly efficient - the only inefficiency we encountered was entirely my fault.  When we walked in I was so stressed that I didn't see the little bell I was supposed to ring to let them know we were there.  Happily a nurse saw us sitting there and came over to ask.

We've been very lucky in that our family has not had much need of local emergency services in our five years here in Versailles.  Last time I was in Emergency was in the U.S.  I was on vacation and had severe back pain and I ended up at Swedish in Ballard in Seattle.  Great service there too and it had the same happy ending - they let me go after a scan.

The biggest difference between the two experiences?  The price tag.  As I recall my little adventure at Swedish cost a little under 1000 USD.  Let's compare that to L’Hôpital Privé:

70.00 Euros for the scan
27.09 Euros for Emergency
23.00 euros for the doctor

That is a little over 100 Euros and when we checked out I was asked to pay a grand total of....

10.02 Euros.

The rest of the bill was entirely covered under French social security and we will even be getting back our ten Euros when we make a claim to our private insurance (mutuelle).

We can argue the pros and cons of how healthcare is paid for in the U.S. versus France (and frankly I think the latter's system is far superior and Obamacare isn't going to come even close to being this good) but I have a very hard time understanding how two private hospitals in two developed countries could have such radically different pricing models.  To be very clear, the level of care was great in both places, the equipment was state-of-the-art in both places, the teams were professional and efficient in both places.

But for some reason it cost 10 times as much to deliver essentially the same care, the same private sector service, in the U.S.

I just have to ask the obvious question:  Where is the much touted American efficiency, business sense and superiority of the private sector over the public in this picture?  

 Bill Maher annoyed people in the U.S. when he said "France has a better healthcare system than we do and we should steal it."  I'm not entirely sure that is true if all you are comparing is quality of care.  What is at issue here is quality care delivered at a reasonable price with the least amount of wasteful bureaucracy.  In that respect  I think the Americans have a thing or two to learn from those "damn French Socialists."


Blaze said...

I'm glad your Frenchlng is OK

I agree. Although our Canadian health care system has issues, I will take it over the American one any day.

I must say, however, I have never had a doctor write a note to Dear Friends!

Many Americans think Canadians are simply Americans with socialized medicine, same sex marriage and gun control. Some say it with a sneer, others with envy.

There's a lot more to it than that. Although we have all of those things, I think they come from underlying differences in values.

Anonymous said...

As a pediatrician I can assure you that your child never had appendicitis. All children under the age of 11 have stomach aches when they have an infection anywhere in the body. All that was needed was a thorough physical checkup (ears?) and when in doubt a blood count. Infusion etc unnecessary. Most general practioners dont know this.

Sally said...

My employer has some business with pharmaceutical and medical device companies. They all want approvals to sell in the US. Why? While the litigation risk is much, much higher, the profits more than make up for it.

If healthcare providers in places like France or Germany try to charge "fantasy" prices, insurance won't pay a cent and they'll go out of business.

Victoria FERAUGE said...

@blaze, I think you're absolutely right - we are talking cultural differences here. And while I firmly believe that no culture is better than another, I think it's perfectly OK to have preferences. I also think it just makes sense to have a look at what the neighbors are successfully doing and then to consider doing the same. Personally I think a lot of the sneering (and I hear it directed toward the Europeans all the time) is fear. Fear that, yes indeedee, these folks are on to something. For them to admit that these systems do indeed "work" quite nicely calls into question their own deeply held values.

@anonymous, Thank you for the compliment! I fear that I am bit older than you think. My daughter is nearly 18 years old. :-)
What had us and our GP concerned was that the pain had been going on for over a week and was getting worse. But you are absolutely right - they did a blood test and a scan and she was fine.

Christopher Mark Perez said...

The costs of healthcare in the US was one of our biggest issues and was what contributed to driving us out of America and into France.

My wife and I were paying $1200 a month for the privilege of holding a piece of plastic that claimed we had some level of access to healthcare. My brother is paying $1700 for the same privilege. That is before we ever get to talking about out of pocket expenses and deductibles.

In researching our move to France, I came across a chart that graphed the costs of care vs quality of care. It was clear that the US was #1 in cost (everyone LOVES a winner!) and, oh, what's this?, #22 and dropping like a rock for quality of care (oh, no, those are not the droids we are looking for).

A little more research and we were able to satisfactorily prove to ourselves that the cost differences between the US and European countries had to do with corporate profit in the form of executive management riches. A for profit capitalist system puts money well ahead of everything else, including patient needs.

If ever the US wakes up and understands that healthcare can be a human right and if they ever wake up and stop enabling/encouraging greed, things might change over there.

Until then, my wife and I will live where the care is #1 in the world (according the WHO) and the costs a _much_ lower than the US.

P. Moore said...

Blaze is correct. Many believe there is little difference between Americans and Canadians, but in fact there are substantial cultural and values differences. You would see and understand them well if you know many Canadians.

As for the question of the quality of care or the superiority of one medical system or another between countries, I believe the 1st criteria is about ACCESS. I think that is a critical driver of outcomes. To me therein lies the importance of Victoria's point about COST. Even though the US has some of the best medical research and certainly some of the world's best hospitals and doctors, somehow according to their own CIA, the French, Canadians, British and about 48 other countries have a greater life expectancy.

Victoria FERAUGE said...

@Christopher, Thanks for sharing that. I had no idea the prices were that high. I do know via a family member who has a small business i the States that the prices are a real problem. His company is committed to providing healthcare to its employees but every year it gets more and more costly. This, he said, has a terrible effect on the business especially their international business. They get outbid by companies from countries that have some form of national healthcare (not developing countries mind you but other developed ones).

@P. Moore - And for Americans to pay all that for an outcome that is, as you so rightly point out, less than optimal, is just amazing.

Rosy said...

Soory to hear about your daughter. You didn't need any morre frights. About emergency rooms here, I imagine you wrote that before the tragic in utero dealth of that baby at St.Vincent de Paul. My experience with my son's epilepsy has brought us to mmore emergency rooms than I can count, in "our" area of Versailles, and elsewhere, since epilepsy generally doesn't let you know it's coming. Much of the waits were for blood test results that didn't come for a week, and the last time, a year ago, in St.Denis, after 6 hours, it was getting late and we had a long trip home, I wrote out a discharge of responsibility, my adult son signed it, and we took an hour-long taxi ride home. Good thing I did. The medecine that was supposed to come - was out of stock ! Private hospitals are excellent - but the public ones are experienceing all srots of cutbacks - the daownside of an otherwise good system.

Christophe said...


Glad your daughter is fine.

Insurance prices in the US vary widely depending whether you insure yourself directly through an insurer and you're not part of a pool, or if you're part of a pool, or if you're insured through your self-insured company. That is profoudnly injust.
Through my company, I can family coverage for $125 a month.
Doctor's fees at our in house clinic are $10.
Deductibles and out of pocket max are reasonable ($500/$3000).
My company offers great health benefits, but I realize that this is an exception, and a privilege. It should not be. We are fortunate.

In my opinion, health insurance should not be provided by companies. Not all companies can afford it, and it prevents people for changing jobs, and limit opportunities. You lose your job, you lose your coverage.

There are a lot of misconceptions about what they call "socialized medicine" in the US - a term that I really don't like. It is not socialism. In France, the government does not provide the services. Private doctors do. The main misconception is that they think that since everyone is insured in countries like Canada or France, wait times are too long, and that you can't see a doctor when you need to.
A lot of insured people here are OK with the fact that price is what limits access to health care, and that if prices were not what they were, that would lengthen the time it takes for them to see a doctor or get the care they need.
That's a pretty selfish (and inacurrate) point of view.
Capitalism pushed to the extreme.

People are pretty selfish when it comes to healthcare here. They don't want the governement to infringe on their liberties to require them to buy health insurance (which increases the cost on everybody else when they go to the ER and can't pay), even if such a system would benefit everyone.

Those are cultural differences that will be hard to change. I might be pessimistic, but I don't think people have the will to change it, because any other system will be labelled as "socialist" and goes against the values of this country.

The core values in the US are more important than what is good for the people. Just like in the name of the second amendment, they don't want to do anything to restrict certain types of weapons, even if it would make sense.

Sorry to sound pessimistic today...

BTW, Victoria, have you received the emails I sent you?

Victoria FERAUGE said...

@Rosy, I didn't know about this "the tragic in utero dealth of that baby at St.Vincent de Paul." What happened? I hear you about the public hospitals - some are great, some are not so great. Budgets cuts.

I was talking with my husband the other day about this post and he said something interesting. He said that before I got sick he was under the impression that there was all kinds of waste and stupidity going on in the French healthcare system. He said he knows better now and while the care I'm getting is excellent, it is the right amount of care with no frills. It was an eye-opener for him.

@Christophe, When I lived in the US I was covered by a health cooperative called Group Health.
They were pretty good and they kept the costs down.

I hear what you're saying about cultural differences. Yes, underlying all this debate are certain values and those are hard to change. I wouldn't lose heart though. Isn't there a great lien about Americans trying everything else before finally getting it right?

Oh and I did get your emails. Thank you. Am slowly reading through them. I'm a bit behind. I'll respond by tomorrow latest.

Shadow Raider said...

"I have a very hard time understanding how two private hospitals in two developed countries could have such radically different pricing models."

Basically, the real cost of health care in the US is not high, it's actually very reasonable. It's the billing system that is totally messed up, on purpose, by the insurance companies. This website, written by a doctor, explains it in detail:

Victoria FERAUGE said...

@shadow raider, That is just OUTSTANDING. I will do a follow-up post tomorrow highlighting it. Thanks so much for the link. What I heard just floored me. Really useful information presented in an understandable way.

In fact I was thinking that his style and format would be perfect for illustrating how citizenship-based taxation impacts average Americans outside the US. I think we should steal his idea and do something similar.