f_0020453_17215

f_0020453_17215 - Hala Kodmani is a French journalist,...

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© 2010 World Policy Institute 29 HEALING PEOPLE, PART III France on $3,000 a Year Hala Kodmani PARIS—In the visitors’ book of the exhibi- tion “Humanization of the Hospitals,” one recent comment observed: “In this museum you’re in a dream. ..It’s so different from the hospital I have to return to next week.” This exhibit of what French hospitals ought to be is essential. The French public may seem like they are all too often persuaded that their health care system—so praised and en- vied abroad, held up as an example even among other developed countries—is one of the best in the world. This isn’t the case. France spends 11 percent of its GDP on health care, second only to the United States among OECD countries. That’s some $3,601 per capita each year, with a public health insurance program that covers 99.9 percent of its population. Almost every French citizen or resident holds a green card, the “Carte Vitale,” which gives access to an efficient and state-of-the-art health system. This electronic proof of coverage carries an individual’s personal information, and by handing it off to a medical center, laboratory, public hospital, private clinic, or even drugstore or physiotherapist, a patient can get whatever treatment may be needed, often without spending a single euro. Health care professionals are then automati- cally reimbursed on the basis of fixed rates for each service or product by the sécurité so- ciale, the public health insurance system, which covers 60 to 100 percent of all costs. The balance is usually reimbursed by a pri- vate complementary insurance company or a mutual fund. Almost all French citizens covered by public health insurance are also affiliated with private, supplementary poli- cies, connected to the government system. Together, they are meant to work seamlessly and cheaply. But to get total and immediate free cov- erage, it’s better to be very poor, very sick or very old. A lower-middleclass, middle-aged worker suffering from a minor flu or stomach ache will find the system lacking. Each visit to one’s primary care physician—a required first step to enter the process of coordinated care—costs $26. The patient is immediately responsible for the €8 not covered by the fed- eral sécurité sociale, then waits for possible re- imbursement from their private policy. Cashing Out “For some low-income people, these small co-pays can be a deterrent—either not to go to the doctor or to postpone the visit,” says Dr. Mady Denantes, a general practitioner working in the 20th arrondissement of Paris, one of the poorest neighborhoods in the French capital. She tells the story of Hala Kodmani is a French journalist, former editor-in-chief of France 24 and author of Les Français Sans Peine (Le Manuscrit.com, 2004).
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Marie, 45, a laborer earning the minimum wage of $1,434 per month, who eventually came to see her after long weeks of pain in her legs. “She was just asking me to prescribe a
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f_0020453_17215 - Hala Kodmani is a French journalist,...

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