French Health Care System – Can it Survive the Excess and Poor Administration?

As a paid up member of the French Health System for the past seven years I cannot help but be impressed by the level and professionalism of the front line service. However as a user, one cannot fail to observe the serious flaws in the way that the system is being administered which will inevitably lead to increased overall costs and a reduction in the quality and availability of the service in the long term.

 

Much has been written about the membership of the French Health System by other EU citizens and the eventual compromise reached in 2007/8 described in some detail on the British Embassy and French Government Health web site. Therefore in this post I wish only to pass observations on my concerns for the future of the system surrounding the administration from the viewpoint of a user.

 

If you are in the system you will be aware of how easy it is to get a doctors appointment; in Brittany this is usually on the same day and if not the next. The doctors are very thorough and will usually undertake a fairly comprehensive examination regardless of the diagnosis. At the end of the consultation you pay the doctor the required fee which is usually 22 Euros. The payment starts a chain of administration which stimulates a letter from the Assurance Maladie, advising you that you have been reimbursed into your nominated account the equivalent of 70% of the cost, the remainder being reimbursed by your complimentary health insurance provider.

 

To summarise, your visit to the doctor has involved a number of different organisations and personnel in responsive actions, i.e. the doctor, the l’Assurance Maladie, the complimentary insurance provider, your bank and the postman!; all for the return to you of the 22 Euros paid. You should also bear in mind that this process is stimulated each time a health service process in accessed.

 

This cannot be cost effective and in its self is generating staff as well as operating costs. Why is it not possible to issue repayments dependant on use, i.e. a regular user could be reimbursed monthly whilst an infrequent user could be reimbursed six monthly of even annually? This is a good example of an organisation creating its own workload.

 

The same process is commenced when you visit the la pharmacie, despite the fact that you do not hand over any money, the pharmacy gets reimbursed the costs of medicines supplied; part from the Assurance Maladie and part from your complimentary insurance. Once again behind the scenes the administration system kicks into action sending letters and money transfers to those involved after every transaction. Clearly this must be costing millions in administration and could easily be dealt with by sensible bulk payments at agreed intervals.

 

So having visited the doctor you leave with a prescription for medicine. Lets just examine exactly what you have been subscribed; lets use a case of ‘la grippe’ (the Flue) as an example. You will have been subscribed an antibiotic, a Pain Killer, a stomach inflammation drug (to counteract the effect of the antibiotic) and usually a cough medicine, in short a sack full of medicine. In my view a lot more than you would have been prescribed in the UK and one has to ask how much of this is really necessary. Our French friends tell us with some confidence that every French home has enough medicine supplied on prescription to see them through any long term national disaster period.

 

In my defence I have tried to reject the quantity of medicine being prescribed, but the doctor has been very insistent, therefore I also have cupboard full of unused medicine which at intervals I return to the pharmacy for safe disposal. I can only presume that behind the scenes there is a profit being made via some form of commercial arrangement.

 

About a year ago instructions were issued to pharmacies instructing staff to recommend cheaper generic alternatives to the prescribed medicines; similar to the approach taken in the UK some years ago. This will obviously help reduce costs but eventually the root of the problem needs to be tackled to avoid waste. One cannot help but worry about all the unused medicines that are already in circulation.

 

It is a great shame that such a good health system is endangered as a result of poor management and administration. We can only hope that someone will get to grips with the problem before damage to the front line service is affected.