Comments from France on the 2013 Commonwealth Fund Survey Pr Isabelle Durand-Zaleski
Jan 01, 2016
Key findings
High population coverage by statutory health insurance
Average:SpendingAccessWaiting times
High complexity and costs of supplemental health insurance
The four paradoxes
Every person is covered but not for 100% of their expendituresSingle payer system for the statutory health insurance (SHI) but huge complexity for voluntary health insurance (VHI)Free choice of physician, but dissatisfaction with accessExpensive for the payer but 2nd worst in financial access to care
Coverage
Good for hospital careMedium for out of hospital with incentives to use gatekeeper and to use genericsVery poor for eye and dental care
Complexity
SHI: ensure that entitlement is recognizedFor means-tested government sponsored supplemental insurance, about 50% of the eligible population has registeredFor employer-sponsored or self paid VHI: complex, opaque (Le Monde survey) with hidden costs
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 2nd worst in financial access
Extra billing: 2013 agreement to limit extra billing to 150% of the official tariff eg 70€ for a specialist visitDirect third-party payment from SHI to physicians (resisted by physicians’ unions)Suggested reforms (not implemented):Out of pocket payments based on incomeFree hospital care