Yesterday xxdr zombiexx posted a diary on the quality of life which pegged Costa Rica as the number 1 country in the world in terms of happiness and being "green", America came in at 114. Some of the commentaries quickly turned to health and France was mentioned as being the number 1 country for its health system. Being French I can report that it is correct (some of you would have read Jerome a Paris's harrowing story about his son and his first-hand dealings with our system) but there is a major factor at work besides having an egalitarian approach by a responsible government: it is called moderation. And moderation is drilled into us from early age through to adulthood and stays with most of us for the rest of our natural lives.
Surely AAF, you jest. What about all this butter you eat? And the rich sauces and the 400 kinds of fatty cheeses? How can a country be healthy with all these endless rounds of croissants dripping with café-au-lait first thing in the morning? I can answer that. Everything we eat (and drink) is, you guessed it, in moderation (including moderation itself). As a young kid I was told repeatedly to eat everything that was on my plate, which I did, including some of the dreaded greens (I wasn't fond of spinach so it turned up regularly disguised as a pureed sauce). As I said in the intro, eating everything but in moderation is drilled etched into our collective skulls ad nauseam. And if perchance you didn't finish what was on your plate then dessert would be a non-starter.
Long strolls usually followed hefty lunches or dinners, especially on the weekends, a practice I have instilled in my kids to this day, is good for digestion, and stretching one's legs at leisure beats watching the idiot box any time. There is a long-standing tradition in France to prepare teenagers to alcohol: on most tables you will find a bottle of table wine, tap water and one kind of mineral water which is used to dilute a small amount of wine. As one reaches sixteen one gets half and half. With this kind of "practice" you will rarely see a French teenager drunk in public let alone one that is being sick on the pavement after too much alcohol.
Apart from a general education in all things alimentary (including spending an excessive amount of time foraging in the countryside and identifying all forms of edibles) another important aspect of foodstuff is that we were taught to read all labels regardless of origin, which you might think is kind of perverse when confronted by words, in say Arabic or English, but there was always someone who would know what it meant.
But our real secret weapon is our liberal use of olive oil as the main source of fat (besides a little butter, now and then) in our diet and our dedication to seasonal fruits and vegetables. We tend to regard bad health as something that can be prevented by following a not so strict set of rules, and that, in return, helps the government and the health services in spades. A healthy attitude and a keen respect of nutrients lead to a better, longer life, IMHO.
Sure, some things have changed since the advent of fast food and France has not been spared, so to speak, with a plethora of fast food outlets and giant supermarkets blanketing all its four corners. Additionally it is not always simple to try and follow this way of life as quite often a combination of low wages and lack of transportation prevents a large segment of the world's population from enjoying a healthy lifestyle, and that is another socialistic diary.
Now a few facts about our health system:
France sees that the whole population has access to care; it dictates the types of care that are reimbursed, and to what degree, and what the role is of the different participating entities.
The State is in charge of protecting patient´s rights, elaborating policies and enforcing them. It is responsible for public safety.
In turn health authorities plan the size and numbers of hospitals. They decide on the amount and allocation of technical equipment (such as MRI, CT scans...). Through its agencies, the State organizes the supply of specialized wards and secures the provision of care at all times.
In recent years, regional authorities have taken a growing role in policy-making and negotiation.
Hospitals:
There are two general categories of which the public sector accounts for 65% of hospital beds. Public hospitals are responsible for supplying ongoing care, teaching and training.
Private hospitals are profit oriented. They concentrate on surgical procedures and depend on their fee-for-service for funding.
There is no significant difference in the quality of care between public and private hospitals.
In France, there are 8.4 hospital beds per 1,000 people (2006 stats).
There are 3.37 physicians per 1,000 people (also 2006).
There was a reform in July of 2005 which put in place a process of coordinated care. The patient first visits his/her médecin traitant (general practitioner). This physician has been previously registered at the caisse d´assurance sociale as the one in charge of the coordination of care for the patient. In case the physician or his substitute is unavailable, the patient can consult another physician and inform his/her caisse d´assurance - this does not affect his/her entitlement reimbursement. The patient is free to change to another general practitioner but has to report the change.
The médecin correspondant (correspondent doctor) is the physician to whom the patient has been referred and is usually a specialist. With the authorization of the patient, this physician sends the relevant information to the médecin traitant in order to follow up and coordinate care.
Several specialists have direct authorization for passing on information relevant to care, such as gynecologists, ophthalmologists and psychiatrists.
The service of gynecologists, ophthalmologists and dentists are covered by the State without a referral by a médecin traitant (the patient does not have to go to his/her General Practitioner first).
The patient has to present his card called "Carte Vitale" which transmits all transactions to the caisse d' assurance where he/she is registered. All medical procedures (hospitalization, laboratory tests, x-rays...) have to take place in the locality of his/her caisse d´assurance. However, the patient can buy medicines anywhere in France and have the reimbursement later deposited on his/her bank account, usually within a ten-day-period.
Roughly an average of 70 percent of the cost of a visit to a family doctor or specialist is refunded. Reimbursements are on average of 95 percent for a major surgery, 80 percent for minor surgery, 95 to 100 percent for pregnancy and childbirth, 70 percent for x-rays, routine dental care and nursing care at home. Reimbursements for prescribed medicines depend on the type of medication and range from 15 percent to 65 percent. These stats I got from the French Ministry of Health & Sports (we seem to associate health and sports together!) and are translated as best as I can with help from the Mozilla add-on.
Under our system a patient can receive 100 percent coverage under certain conditions, such as having a chronic or acute medical condition (including cancer, insulin-dependent diabetes, heart disease...), requiring long-term care, having a long-standing condition, requiring a hospital stay of more than 30 days. I give you another example: I lived in Australia for some 20 years and as I had made the acquaintance of the French ambassador stationed in Sydney, I once mentioned to him that my lungs were a little on the dysfunctional side. He responded that if I were to choose to be treated in France he would organize a free return trip and a member of his staff would co-ordinate everything else. I was greatly surprised by the offer, he shrugged and said that this kind of offer is available to all French citizens living abroad.
As for what some wingnuts call "socialized medicine", they are so far from the truth it's embarrassing. We do not consider our system socialized though most don't see anything wrong with calling it as such. France, like the United States, relies on both private insurance and government insurance. Also, just like in America, (some) people generally get their insurance through their employer.
France has a reputation for central direction but French healthcare is based on a compromise between egalitarianism and liberalism. All citizens are said to be equal, and choice and competition are fiercely protected.
In fact you might say that the French want pretty much the same thing as Americans: choice at affordable rates. Summing up this hastily written piece, moderation is all. Repeat, lathe, rinse.