Tue, 20 Mar 2007
Here's a homework assignment I had to do for Comparative Economic Systems. The
reading assignment was Paul Dutton's Health Care in
France and the United States: Learning from Each Other.
Pros and Cons of US and French Health Care Systems
The US health care system is criticized for lack of universal health insurance
coverage in comparison to the French system. Because French insurance is
essentially compulsory, health care costs are more broadly distributed amongst
the entire population. Although laws in the US that mandate certain types of
medical care be provided to uninsured (and otherwise non-paying) patients raise
medical costs for the insured, these higher medical costs are borne by those
others seeking medical care rather than society at large. Except for the case
of highly communicable diseases, the treatment of which provides a large social
benefit, this is arguably a more just outcome.
In both the US and France, patients have a number of choices in seeking medical
care. In France, patients can generally get treatment from a specialist
directly, whereas in the US, the growth of HMO's means that many patients must
get the approval of a "primary care physician" before seeking specialized
treatment. This latter system can be frustrating to patients, but may also
conserve the resources of more costly medical care when the primary care
physician deems it unnecessary. Patients in the US have the option of
purchasing PPO insurance, which has either a higher premium or deductible, but
which provides the patient with the option of seeking specialists' treatment
directly. Even under an HMO, the threat of lawsuit means that all but the most
trivial concerns would likely be approved for specialist review.
Differences in malpractice awards, and thus insurance premiums, contribute to
widely divergent costs for medical care in the two countries. Although per
capita medical spending in the US is twice that of France's, only a portion of
the difference goes towards malpractice insurance and repaying debt incurred in
medical school, the bill for which is footed by the government in France.
Doctors enjoy much higher salaries in the US. Medical care providers have much
more leeway to negotiate fee schedules with US insurance companies than their
French counterparts whose negotiations occur between physician associations and
the quasi-public insurance funds.
Doctors in the US may also profit from increased productivity through the use
of technology when compared to French physicians. On the other hand,
standardization of billing processes in France does reduce billing costs.
Health care providers in either country which can both standardize and automate
administrative tasks should profit by doing so.
Both the US and French health care systems suffer high costs associated from
the use of "insurance" for routine medical care in which the primary
beneficiary does not bear the full cost of services. Regulation also prevents
insurance providers from properly pooling policies by risk group, raising
insurance premiums overall. Health care systems in general would benefit from
decreased regulation and a move towards a system in which insurance returns to
a role of providing for contingent, devastating medical emergencies among
groups for which the likelihood of such events is approximately equal.
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