Monday, 28 November 2011

French health care: vive la difference!

IT’S the best in the world; France’s healthcare system is held up as a model of good practice. It’s where you want to be if you get sick.
But when you look at how the system works, it’s not unlike what Mary Harney wants for Ireland. Except for one thing. 
“What’s important is to make sure that the private sector would not be like a poker player and only interested in the money, and to ensure that they stay focused on the main topic which is healthcare,” says  Gabriel Ko.
Dr Ko has worked in Ireland and in France - he is a biopathologist, formerly the leader of the French junior doctors, and now works for Claymon-Biominis and for the French government.
He admits: “When I saw the salaries of the Irish doctors, I said: ‘Oh my God, I should definitely live in Ireland!’”
French doctors earn, on average, from €50,000 to €100,000 a year. Not a fortune - but a solid income.
From the patient’s point of view, it’s a great system. Everyone over the age of 16 has a ‘treating doctor’ - usually people choose a GP - who coordinates any medical treatment the person needs.
A visit to the doctor costs €23. If your doctor sends you to a specialist, that visit will cost you €25. 
There are three ‘sectors’ of doctors - Sector 1, in which most GPs are; and sectors 2 and 3. Sector 2 docs charge more, with part of your payment covered by social security and part reimbursed by medical insurance. Sector 3 is tiny - about 1.5 per cent of French doctors - and more absolutely private. This includes a lot of alternative medicine practitioners. 
“Sector two  means that you will be allowed to charge whatever you want to charge a patient, but you have to do it with a certain measure,” says Gabriel. 
“You have to ask the patient if he’s got any private insurance, or any kind of money to pay that.
“Roughly, to give you an idea, in Paris for a gynaecologist in the private sector, the average charge for consultation would be €60 or €70.
“But out of that up to €25 will be reimbursed from Social Security, and the difference between €25 and €70 would be more or less reimbursed by your private insurance.”
You can also choose a specialist not recommended by your doctor - but then you’ll have to pay out of your own pocket. 
Hospital is different too. “With regards to hospitals: we don’t have such a definition of consultants like in Ireland,” says Gabriel. 
“What we would have is senior doctors.  and the majority of the senior doctors are not allowed to ask anything more than the hospital will ask of the patient.
“If you’re going to the cardiology department or going to the pathology department you would have a consultation or even full hospitalisation, and then you will be charged directly by the hospital.
“The doctor would charge you exactly the same as any other doctor: this is the price that is fixed by Social Security.”
Professors or heads of service are allowed to work privately within the hospital - but this is limited to around two-and-a-half days a week.
 “But at the end of the year the public service look at how much they asked to the patient in this private activity,” says Gabriel.
“So if you are making  €1 million as a doctor working in the private sector, well that’s something that will not be tolerated.”
If you’re in an accident or taken suddenly ill, you call for help - but what arrives isn’t an ambulance. It’s the SAMU (Service d'Aide Médicale Urgente).
This is a specialist team, led by a doctor, which may include doctors, nurses and a driver, and is qualified to give emergency treatment on the scene or transfer patients to hospital as needed.
“For the French patient I think the system is quite good,” says Gabriel. 
Published in the Evening Herald, Dublin, Ireland, in June 2010


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