Comments from france on the 2013 commonwealth fund survey
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Comments from France on the 2013 Commonwealth Fund Survey. Pr Isabelle Durand-Zaleski. Key findings. High population coverage by statutory health insurance Average: Spending Access Waiting times High complexity and costs of supplemental health insurance. The four paradoxes.

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Key findings
Key findings

  • High population coverage by statutory health insurance

  • Average:

    • Spending

    • Access

    • Waiting times

  • High complexity and costs of supplemental health insurance


The four paradoxes
The four paradoxes

  • Every person is covered but not for 100% of their expenditures

  • Single payer system for the statutory health insurance (SHI) but huge complexity for voluntary health insurance (VHI)

  • Free choice of physician, but dissatisfaction with access

  • Expensive for the payer but 2nd worst in financial access to care


Coverage
Coverage

  • Good for hospital care

  • Medium for out of hospital with incentives to use gatekeeper and to use generics

  • Very poor for eye and dental care


Complexity
Complexity

  • SHI: ensure that entitlement is recognized

  • For means-tested government sponsored supplemental insurance, about 50% of the eligible population has registered

  • For employer-sponsored or self paid VHI: complex, opaque (Le Monde survey) with hidden costs


Choice and dissatisfaction with the system
Choice and dissatisfaction with the system

  • Patients want to choose their physician, not their insurer (evidence from the government-sponsored program)

  • Dissatisfaction with access:

    • Télémédicine experiments


Expensive for the payer but 2 nd worst in financial access
Expensive for the payer but 2nd worst in financial access

  • Extra billing: 2013 agreement to limit extra billing to 150% of the official tariff eg 70€ for a specialist visit

  • Direct third-party payment from SHI to physicians (resisted by physicians’ unions)

  • Suggested reforms (not implemented):

    • Out of pocket payments based on income

    • Free hospital care


National strategy 2014
National strategy 2014

  • Increase generic use

  • Reduce medication volume

  • Control medication costs

  • Fight against fraud and abuse


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