Global Health Care Systems: USA vs. France
France was chosen as the country for the current analysis because health care systems of the US and France have much in common and its experience might be useful in coping with the same problems in the United States. Both countries can be definitely called the states with high level of well being.
The health care system improves constantly, people try to lead healthy life styles and they have all opportunities for it. As the result, both American and French health care systems face similar problems, connected with the increasing number of elderly people and constantly growing prices for health care. The United States face the financial problems with governmental payments on medical insurance, which result in the serious budgetary problems in certain states. France also experiences problems with governmental financing of the health care, which leads to conflicts with the European Monetary Union. The French and the American health care systems are based on the same fundamental ideas. That is why it is crucial to analyze their strengths and weaknesses in order to learn how to improve the American health care using its European counterpart.
Health Statistics and Costs
According to the statistics, the life expectancy among men in the USA is 76 years, while in France it is 78 years. The life expectancy among women in the United States is 81 year, while in France women live 4 years longer, 85 years (World Health Organization, 2014, p. 153). Mortality rate in the France is 120.99. The death rate in the USA is 141.23, which is 17% more than France. The mortality rate among children is also high in the United States, which is 6.8. In France it is 3.2, which is two times less than in America (World Health Organization, 2014, p. 152).
It is possible to assume that heart diseases, obesity, cancer, and HIV/AIDS are among the most serious diseases in the analyzed countries. People in the United States suffer from cancer 16 % rarely than in France, which is 133 comparing to 154. The number of deaths from heart diseases is also 3 times higher in the USA than in France: 106.5 per 100.000 people comparing to 39.8 per 100.000 people. There are 150.000 HIV/AIDS positive people in France. In the United States this number is 8 times bigger, 1.2 million (Rice et al., 2013, p 225). The last illness that is necessary to mention is obesity and the United States are on the 1st place in the world judging by the number of people who suffer from it. It is 30.6 % comparing to only 9.4 % of obesity rate in France (World Health Organization, 2014, p. 154).
The statistical data shows that generally people in France live more and better than in the United States. The death rates both among adults and infants are lower, less people die from illnesses connected with the heath problems and less people are HIV/AIDS positive. It is possible to assume that the main problem that causes both high mortality rates and the serious heart diseases is obesity. The problem is not new in the United States and both the government and the health care try to fight with it (Holtz, 2008, p. 5). However, the results are not very optimistic and the Americans are still the heaviest nation in the world. Perhaps, with the elimination of the obesity problem the US health system might become more efficient.
Health Care Financing
French and American health care systems have similar sources of financing. Primary care in both countries in private. The health care in the US and France is divided into privately and publicly financed sectors. People generally rely on their private health insurances, that they purchase or get as a bonus at work (Holtz, 2008, p. 1). The taxes the employees pay go to the public budget on health care and them are spent on the primary care needs, extra urgent cases and social programs. The US government has publicly financed health care insurances like Medicaid (Holtz, 2008, p. 3). The states receive money for these programs from the federal budget under the Affordable Care Act.
Publicly financed health care also exists in France. It is financed mainly by the payroll taxes the organizations and the employers pay, the taxes on alcohol and tobacco, and the subsidies from state. People also buy health insurances and it is related to the privately financed sector of French health care. The basic heath insurance is called VHI. People usually buy complementary insurance SHI that provides more dental and eye care (Chevreul et al., 2010, p. 35).
Health Care Administration
In the United States the heath care services are regulated mainly by the federal government and the Department of Health and Human Services in particular. It is divided into 5 smaller state organizations. The National Institute of Health is responsible for general research in the sphere of health care. The Agency for Health Care Research and Quality tries to investigate into the ways of improving the safety and quality of the American health care. The Health Resources and Services Administration works with providing medical services to the vulnerable part of population, isolated or uninsured people. The last state division is the Food and Drug Administration that controls the quality of vaccines, drugs and food (Rice et al., 2013, p. 25).
The main government agency that regulates the health care in France is the Ministry of Health. It creates the current policy concerning the health care issues and implementы them in practice. The trends in the medical sphere in France are determined by the Public Health Act. The Ministry of Health also controls the expenditures on the public health care, the prices on drugs and payments to the doctors. Another state agency is the French Health Products Safety Agency that is responsible for all questions about health production, their quality, price, and even marketing. Another governmental organization called the National Agency to Support the Performance of Health and Social Care is responsible for advising and helping the hospitals. They provide them with medical equipment, money, reorganization plans in order to avoid injustice in providing health care to vulnerable French populations like the poor, the elderly, the disables or children (Chevreul et al., 2010, p. 46-47).
Health Care Personnel and Facilities
According to the statistics, there are 2.3 physicians and 9.81 midwives and nurses in the US per 1,000 people. In the United States 70 % of hospitals are nonprofit, 15 % are public and 15 % are for-profit. The hospitals receive payments from different sources. They include bundled payments, per-case payments, per-diem or per-service payments. Some of the doctors are employed by hospitals and as the result receive salary monthly. However, the majority of the physicians are payed for the particular services. Their work is not included in the Medicare insurance and diagnosis-related group of payments. For this reason the position of the hospitalist gains popularity in the US hospitals (Holtz, 2008, p. 4).
The number of nurses and midwives in France is 6 % lower that in the United States, which is 9.3 per 1.000 patients. However, the number of physicians is 47 % more, which is 3,37 per 1.000 people. Nearly 67 % of the entire capacity of the French medical care constitute public hospitals (Touraine, 2014, p.1101). They are responsible for 42 % of all outpatient cases ad 65 % of inpatient episodes. Private for-profit hospitals have a narrow specialization, for example coronarography or endoscopy. They account for 50 % of outpatient and 27 % of inpatient cases. The rest of the cases are under the responsibility of the private non-for-profit health care organizations. They also deal with the treatment of cancer (Touraine, 2014, p.1102).
Access and Inequality Issues
Despite the high level of medical care and the average well being of both American and French citizens, there are still many problems in the social sphere. Many people do not have access to the professional medical help and often face inequality issues. As it was mentioned earlier, only those who have purchased insurance have access to the medical care. However, in case of France a person needs to have a complementary insurance if he/she has problems with eyes or teeth, and in the United States the consultations of the physicians are not included into the Medicare insurance. As the result, those people who do not have enough money to buy complementary insurances in both countries have problem with accessibility of medicine (Holtz, 2008, p. 8). Though, the percentage of those who can not afford buying the basic insurance is rather high in both countries. In this case, the uninsured people can count only on urgent medical help, that is free for all people or governmentally sponsored insurances like Medicaid (Holtz, 2008, p. 10). The attempts to reduce the level of social inequality became the major issue both in the French and the US policy in 2014 (Nolte et al., 2008, p. 56).
There are many common issues in the health care systems of France and the US. Administration, financing an even social problems are similar. Both countries try to decrease the inequalities in their societies and make their nations healthier. Despite evident similarities the statistical data concerning health in France is better than the one in the US. That is why it is possible to assume that the reason for it is not in the health care system, but in the life style of people.
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Rice, T., Rosenau, P., Unruh, L. Y. et al. (2013). United States of America: health system review. Health Systems in Transition 15(3), 1–431.
Touraine, M. (2014). Health inequalities and France’s national health strategy. Lancet, 1101–1102.
World Health Organization. (2014). World Health Report 2013. Statistical Annex, pp. 152-155.