Healthcare Systems in the United States and France
Critics of the U.S. health care system often offer to reform it by using foreign models. However, a careful study of the situation shows that health systems in almost all countries in the world are faced with the problems of rising costs and inaccessibility of health care for the population. A universal model of healthcare organization being suitable for everyone does not exist. French healthcare system was chosen to be compared with the United States’ one as both countries have a well-developed system of health insurance, although a significant role in health care of the population belongs to private sector. The social security system in France has a fairly sophisticated device. It is mandatory for all citizens and solves many issues concerning health, employment, payment of pensions, allowances for pregnancy, maternity, occupational diseases, etc. Almost every citizen of the country irrespective of his/her level of well-being is entitled to minimal healthcare insurance. Comparing it to the United States’ system, a sixth part of the population do not have insurance in case of illness. There are both similarities and differences between healthcare systems in France and the United States, but none of them can be considered as an ideal one.
Health Statistics and Costs
The United States is “the leader in healthcare spending, as a percentage of GDP, as compared to other developed countries” (Holtz, 2008). In France, public spending counts 53 percent of GDP. It is “the second-highest percentage in the developed world” (Lundberg, n.d.).
“With respect to infectious diseases, HIV/AIDS rates have declined because of new antiretroviral medications” (Holtz, 2008). Moreover, Holtz (2008) emphasizes that the life expectancy of Americans is not the highest in the world. This shows that the American health care does not show higher outcomes than French system despite the U.S. government spends much more money than French one.
Health Care Financing
In the United States, private business system is mostly paid system, which is financed from the personal funds of the population. Health care is provided primarily on a fee basis. The dependence of the medical care volume on the size of the contribution is the main difference between private and social insurance. Main governmental programs are Medicare and Medicaid. Medicare is a unified national program of health care for the elderly and disabled people. The right to use the program is given to those people who reached 65 years, receive social security benefits, and have work experience from 5 to 10 years depending on the nature of the work. Medicaid is a state medical assistance program for low-income families. It is subsidized by the federal government but regulated by state laws. The family has the right to receive benefits under this program if its income is below the set level.
In France, the financing of social health insurance for employees and similar groups is carried out by workers and employers. The funds for social insurance come from security insurance in a centralized national sickness insurance capital. In France, there are several insurance systems. General insurance system is the largest system that includes the employers in industry and commerce, civil servants, students, disabled veterans, war widows, orphans, and doctors. The state does not practically participate in the financing of the common system. Special systems include the system of miners, merchant marine, and military personnel system. Specific insurance systems represent greater benefits to the insured citizens than the general system of social security, but it requires longer work experience.
Social insurance system is the most recognized in the world. This system is also controlled by the public authorities but is funded usually from 3 sources: subsidies of the state, earmarked contributions of employers, and contributions of the employees themselves. The distinctions between public and insurance systems are related to the formation of funds. Insurance funds are formed on a dedicated basis and are designed for a certain group of people who are involved in relevant insurance programs.
A significant role in French healthcare system is played by the public health service. All medical institutions in France can be divided into three types: public hospitals, private clinics, and charitable structures. The highest authority is the French Health Ministry of Health and Welfare. Formally, the management of healthcare in the United States is realized by the Department of Health and Human Services, but its function is very limited. It includes public health service and deals only with the issues of medical care (inpatient and outpatient) for certain population groups: veterans, merchant navy seamen, members of the armed forces, civil servants, and the American Indians. Each state has its own health department; its functions are reduced to the issues of sanitary and anti-epidemic protection.
Health Care Personnel and Facilities
French law provides a number of different and comprehensive rights to the people in healthcare industry. The system of medical care in France assumes patients’ equal access to the doctors of any type (including specialists) regardless of whether the latter work in public (hospitals) or private (clinics and medical offices) sector. In private sector, there are commercial and non-profit organizations. By law, all these structures are obliged to share medical information with each other.
The medical aid organizations in France include outpatient care. Self-employed doctors, who have concluded an agreement with social security authorities, dominate in the provision of community care. In the United States, private doctors are paid directly by patients or insurance companies. French healthcare system is characterized by combined universal coverage with a public-private mix of ambulatory and hospital care. The American health system has a lower volume of service provision than the French one (Rodwin, 2003). However, French specialists in the field of healthcare system “earn about a third as much as their US counterparts” (Dolan, 2011, n.p.).
In recent years, group practice in France becomes widespread. The team may include doctors and various specialists. Hospital care in France is provided by public and private hospitals. Public hospitals are divided into 3 categories: local or rural hospitals, general hospitals with a wide range of medical services, and clinical hospitals with teaching and researching base. The same situation is observed in the United States. American government programs are reduced to providing healthcare services for the elderly, disabled people and some groups of the poor. Private and public medical insurance programs differ in the number and quality of the benefits, different sources of funding and provide a variety of value cash payments to medical workers and health facilities.
Access and Inequality Issues
The U.S. and French healthcare systems are based on the principles of liberalism and pluralism; and thus meet the requirements of a market economy, have differences between local institutions and the right to choose. Nevertheless, both American and French healthcare systems face issues and crises of unprecedented scope. In both countries, there is growing number of elderly population. In the United States, healthcare inflation imperils Medicaid and Medicare and causes federal budget deficit. In France, insufficient resources lead to demonstrations and strikes among doctors. In recent years, due to the large influx of immigrants and limiting release of nonprescription drugs, the country has problems with an access to the selected specialist. In an attempt of improving social responsibility of citizens, the government is gradually increasing their share in the payment of received services.
The United States and France have many similarities in their healthcare systems. However, the United States is almost the only country in the world that is characterized by private medicine and private voluntary health insurance. In contrast, France mostly has an insurance system based on the principles of solidarity. It is closely connected with the whole system of social insurance and is governed by a single law. Both countries have problems of ensuring equal access to health care, payment of health services provided to people from high-risk groups (elderly, poor, and disabled), and optimal allocation of financial resources among groups of insured. The French model of health insurance is characterized by effective integration of the whole system of social insurance. In contrast, for the majority of the US population, the health insurance is a private matter. Nevertheless, it should be emphasized that the United States develop and implement effective medical technologies, deploy advanced research, and, as a result, successfully provide high-quality medical care. Therefore, it could be concluded that in spite of the variety of medical care forms, there is apparently no country that would have been completely satisfied with its own healthcare system.