signWe are a little too well-acquainted with the emergency rooms. The most recent visit comes after much time spent in U.S. hospitals last year (as visitor). The differences are striking.

U.S.: imposing marble lobby, with a volunteer playing a grand piano. Food court. Gourmet coffee stand emitting good smells. Carpeted halls. Rooms that look a bit like hotels if not for the high-tech control panels and machinery. Heated blankets. A sofa in the room that turns into a kind of bed for a family member keeping watch. Another hospital went for an earthy, natural décor, with lots of warm wood, and tiles and wallpaper that had grass or leaf designs. Very zen.

France: sun-filled linoleum lobby. Linoleum, in fact, is the most prevalent material. Wall-to-wall carpet is considered a germ trap in Europe. Plastic seats–no upholstery. No attempt at décor (white walls with a green accent wall, pale gray floors) except in the pediatric wing, which had animal decals on yellow walls. The emergency room at one private hospital did, however, have as decoration framed x-rays of unusual objects, which provided a distraction. It also had wood paneling. In the patient’s room: a small table, a rigid plastic chair, a very ugly lump of an armless chair that unfolded into a surprisingly comfortable bed for a family member keeping watch. A sheet but no blanket (certainly not heated) nor pillow for said family member. No food court, and the lobby vending machines are locked up after hours (i.e., after 6 p.m.).

front
Carcassonne’s new 496-bed hospital opened in the summer of 2014.

So far, it sounds like the U.S. is better, BUT marble lobbies don’t make a person well. And they might make one sick when the bill arrives.

On the other hand, the bill for an x-ray of a possibly (but thank goodness not) broken shoulder? Zero.

And the bill for an overnight after our kid passed out on a school outing (why breakfast shouldn’t be skipped…lesson learned)? Minors who lose consciousness are required to be kept for 24 hours of observation. Zero.

And the latest–meningitis, which turned out to be the viral kind, not the deadly bacterial kind? Until the blood test confirmed that, our kid was treated with a speed that was amazing. And kept overnight for observation. Again zero.distant

This isn’t to say that we don’t pay for health care. There are mandatory social charges in the form of a 6.5% tax on income of self-employed workers; salaried workers pay 0.75% and their employers 12.8% of their wages, for a total of 13.55%.

According to the Bureau of Labor Statistics, the average cost of health insurance benefits to employers was 7.6% of total compensation, but that ranged from 12.6% for union workers to 6.9% for nonunion workers. On average, employers of higher-paid workers cover a bigger share; lower-paid workers get less.

It’s hard to get an average percentage for the employee contribution in the U.S. The Kaiser Family Foundation found that average annual family coverage premium is $17,545, with employees paying $4,955 of it. And the average deductible for a single (they didn’t give family figures) is $1,077.

There are no deductibles in France.

checking-phoneThere are co-pays, however. The full price of a doctor’s visit in France is €23, of which the government reimburses 2/3, or about €15. I suspect it’s set up that way–patients have to fork over the €23 and wait for reimbursement–to set the bar just a little higher for whether one really needs to see the doctor. You can buy supplemental insurance to cover the co-pays.

In the U.S., the average copayment is $24 for primary care and $37 for specialty care, for in-network providers, according to the Kaiser report.

In France, all providers are in-network. You get to pick your doctor, from any of the doctors in France, not from a list provided by your insurer. And no surprises coming out of anesthesia to discover a bill bigger than your annual salary because most of the doctors who touched you were out of network. Obamacare has put a cap on out-of-pocket expenses (the sky used to be the limit): $6,850 for an individual and $13,700 for a family. However, medical bills are still causing personal bankruptcies in the U.S.

left
Note the covered sidewalk. The old hospital had one as well. A brilliant idea, in rain or sun.

Two people I know in France have hereditary kidney diseases. One just got a transplant; the other has been hospitalized a lot but isn’t yet at the transplant stage. One thing they don’t worry about is the cost of treatment. Ditto with friends who have cancer. One quit her job–but she didn’t lose health coverage because that has nothing to do with where or whether one works.

It seems logical to separate health care from employment. And to pay for it with a tax so that those with more money pay more and so that your health expenses aren’t at the mercy of your job or the genetic lottery. For those unfamiliar with the U.S. system, the New York Times a couple of years ago ran an excellent series titled “Paying Till It Hurts.”

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29 thoughts on “Urgences

  1. The French system works much like the Australian one and our personal experience of it has been very positive. We were especially impressed by how quiet and calm the Urgences section of a big teaching hospital was on a Saturday night when we arrived with our detached retina just after another group involved in a car accident were delivered. No drunks or drug addicts causing distruption (unlike what you would get in the UK and Australia). I’ve never had to use the US system, but we get a lot of doctors and CEOs as clients so we talk about the health care system a lot with them (they raise the topic usually and are really curious about what we pay and the level of service). The UK system has made the mistake of making it free at the point of delivery. I once visited the migraine specialist based in a hospital. I was very early because my train times didn’t co-ordinate neatly with my appointment time. I got in straight away because the previous 9 patients had not turned up! The other good thing about the French system is that the money paid into the system is ringfenced. Unlike the Australian and UK systems it can’t be sidelined for other government projects. Also in France we are very aware of how much we pay because it is paid separately to income tax and salary deductions. The Pay As You Earn system of deducting National Health System contributions directly from salary before employees even see it is another reason they are so cavalier about appointments.

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    1. The unusual thing about the U.S. system is that it’s for-profit. Insurers make money by not paying claims. There’s no price list–insurers negotiate prices, which means that those with no insurance or bad insurance (the working poor, because the poorest are covered by Medicaid) pay the most. This podcast is interesting: http://freakonomics.com/podcast/how-many-doctors-does-it-take-to-start-a-healthcare-revolution-a-new-freakonomics-radio-podcast/

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      1. That’s a very good point and one I forget because I’ve always lived with a ‘socialist’ system. Here, although the administration of the basic health insurance is privatised, the State sets the rules about what must be covered and how much can be charged. The profit is made by being efficient and making sure people don’t get sick in the first place (we had a day at the heart clinic as part of a pilot by our health insurer, on the grounds that it is cheaper to monitor people in the at risk categories early than pay out when they have a heart attack).

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      2. That was the premise of health maintenance organizations in the ’80s in the U.S. But it didn’t work out because they were for profit. If people change jobs, they get new insurers, and the old insurer loses the benefit of having kept them healthy.

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  2. Yes I agree the hospitals here are very bland and definitely no restaurant for visitors but plenty of places to sit and eat your own brought in food at ours, sadly I have had the misfortune to have spent several days in hospital or the big house as we call it but the treatment and service were second to none.

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  3. I have worked in healthcare in the US for 36 years, and our system is horribly complex and broken. I do agree that health insurance should be de-coupled from employer benefits. It’s the patients and the healthcare providers (doctors, hospitals) that get caught in the middle with government programs and private insurers. It’s so complex now that it needs to be scrapped altogether and a new system implemented, but that’s too daunting for anyone to figure out. People in the US are too used to getting everything they want, but no one wants to pay for it. I’ve heard nothing but good things about healthcare in France, thanks for the post to compare! Hope your son is doing well now.

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    1. I think people in the U.S. who don’t want to go to a single payer system don’t realize what they could gain, and that they really wouldn’t lose out. They have something familiar that more or less works for them, and they don’t want to change. But their employer could change it at a moment’s notice.

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  4. This a very interesting post. The health care system in Canada is universal for all. Yes in some cases it is two tier….but even people who have never paid for insurance are covered. I do not understand it completely. I think that our system rates between the US and France in accessibility. I have heard that in France doctors make house calls.
    Glad to know that your daughter is fine….

    Ali

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      1. Yes, our doctor (general practitioner) makes house calls. He does house calls in the morning and surgery in the afternoon (as in you visit him at his cabinet). It costs a bit more to have him visit you at home.

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  5. FranceTaste — love your blog and just signed up. If you’re on Instagram you can check out my food adventures @susaomega You mentioned in Smitten Kitchen comments that you have tips for eating out in Paris and Carcassonne. We may be travelling to both in 2017, and would love it if you could forward your tips. I submitted my email for this comment, let me know if you don’t have access to it. Mille mercis!

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  6. Some of the younger docs coming along seem to be aware of how badly the US system is broken, but can’t yet do much about it. Or they change: An acupuncturist I used to go to started out as an ER nurse in a big city, said she realized she wasn’t helping people get or stay healthy, so found another route.
    I thought about changing insurance providers last year, but as I read the fine print realized I’d have to get new doctors, even though quite healthy, so stayed put. A lot of people do that, I think. And it’s not even the cost of the docs so much as the incredible price of some of the meds. Mind-blowing.

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    1. Yes, and only the U.S. Is paying those prices. Even though a large part of the R&D is subsidized by the government.
      My doctor is possibly the richest person I know around here. BUT the scale here vs. the U.S. Is what is so different. Being twice as rich or three times as rich is enough here. In the U.S., it’s a different magnitude.

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      1. Part of the problem is that shiny new docs coming out of school now have crippling student loan debt, sometimes well into six figures. And more and more of them are working as salaried for big health-care corporations that are swallowing up the hospitals.
        We’ve seen this business model before, and it generally does not end well for the consumer.

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      2. This is an excellent point. In France, university (and med school) are not nearly so insanely expensive. My friends complain about how their budgets are bleeding with kids in college, but it’s NOTHING compared with the U.S. Ditto for malpractice insurance.

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  7. I self-pay my own insurance in the US and it works anywhere in the world as if it is cash. I have been hospitalized in Prague for food poisoning and walked out without a bill because it was paid 100% by my insurance. I can go to any doctor, for any thing, at any time and never have to worry about a network.

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  8. Hi there, so glad your daughter will be OK — how scary! You mention taxes but didn’t mention the huge chunk of social charges that those of us working in France pay as well. When people back home refer to “high taxes” in France, they lump income tax and social charges together under the same umbrella and it does seem like a lot. But to have solid health care that isn’t tied to your employment is worth it in my opinion. Less to worry about!

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  9. Thank you for breaking down the differences between the French and American healthcare systems. The French system is way better, and more humane, than the American system. They also do a poor job of explaining your expensives and benefits, when you choose a plan.

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  10. Excellent post!! I am curious what hospital you were visiting in the US…your description certainly did not match any hospital I have ever seen! Marble entrance halls with pianos? Carpeted halls and cushy furniture? I want to go there next time I need the hospital!!

    So many Americans are against single payer health insurance because they believe it is “socialist” and therefore unAmerican. They are against an increase in taxes which would be necessary to cover health care for everyone because they fear that we are already paying too much tax (we have been told by certain politicians that we pay the highest taxes in the world…which is not correct, but people believe what they want). It’s a head scratcher to me.

    Liked by 1 person

    1. A Catholic hospital in the Midwest. But I went to several different ones with my parents, and they all had the same style–fancy lobbies, pretty fancy rooms. It’s true that the NY hospital where I gave birth was not as fancy.

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