Has anyone told the French yet?

That their health system is stuck in the 1930s?

Dr Mark Porter, chairman of the BMA’s hospital consultant committee, said…….

Dr Porter said in an interview with The Guardian: “Very deliberately the government wishes to turn back the clock to the 1930s and 1940s, when there were private, charitable and co-operative providers of healthcare.

\”But that system failed to provide comprehensive and universal service for the citizens of this country. That\’s why health was nationalised. But they\’re proposing to go back to the days before the NHS.”

Or perhaps someone should point out to Dr. Porter the inanity of his statement.

For the French health care system (the one, recall, which is routinely described as the best in the world) relies upon exactly that mix of charitable, for profit, co-operative and government direct provision to run that health care system.

What differentiates the French system from the UK system circa 1930 is the universality of insurance that the French have, not the single monolithic supplier of services that is the NHS.

Which leads to us to an interesting questions. If that French system, depending as it does upon a fractured supply network (one that therefore allows, indeed insists upon competition between suppliers) but a unitary financing network, produces the best health care system in the world, what actually is wrong with moving the NHS to the system that produces the best health care system in the world?

Again, if government paying for health care through a competitive market, through a mixture of both providers and types of provider, produces the best health care system in the world, why aren\’t we doing that with the NHS?

15 thoughts on “Has anyone told the French yet?”

  1. Oh dear! You just don’t get it, do you Tim? The NHS is the envy of the world! Or so I keep being told when I try to contrast it with the systems in force in Germany, Norway, Switzerland, France, Singapore and others I’ve experienced as patient or friend of a patient.

  2. I wonder why someone who earns an extremely good living from a monopoly provider would fear a system where competition among suppliers was prevalent

  3. The ‘Mail’ today has a story about a teenager that deliberately exaggerated foot pain in order to get foot surgery on the NHS so she could wear designer shoes.

    She claims she doesn’t feel guilty.

  4. I once met a woman who had experienced the French, Canadian, Icelandic and British systems. She rated the British worst by a large margin, but rated Iceland above France.

    I’ve heard people speak well of Australia and Singapore.

  5. Philip Scott Thomas

    Is this the same Dr. Mark Porter who present the “Case Notes” programme on BBC Radio 4? You know, that other huge, monolithic provider that loathes the competitive market?

  6. The ConDem reforms have got nothing to do with moving us towards a (natch, higher investment) French/European social insurance model. They are about handing great chunks of infrastructure/capacity to the private sector (read: Serco), in a way that NuLav envisaged – but never managed.

    The NHS may not be perfect & (its performance at its best does not excuse the service at its worst), but these reforms threaten to derail what it can do well. Nor will they solve existing issues – I’m willing to bet that handing over care budgets to big consortia (prob dominated by the likes of United) or elective surgery to Cinven (PE owners of Spire) isn’t going to improve the state of elderly care wards or overstretched maternity units. But the shareholders will be pleased.

    Quite frankly, fcuk the ConDems. There will be grim scenes in acute care – and on their heads be it.

  7. I’m willing to speak negatively of Australia. Sure, it’s better than the US – but it fails at the most basic level of emergency healthcare. If you get hit by a bus, then you need to pay $1000 for your ambulance to hospital.

    As in the US, hospitals won’t refuse to treat a tramp – but if you’ve got $1000 to pay, or any chance of having a credit rating, then you need to stump up the money, and Medicare won’t reimburse you. It’s pretty fucking revolting.

    The French system, on the other hand, is perfectly sensible – and a nominal co-payment for GP visits in England would do wonders for “getting rid of sixtysomething hypochondriac ladies who currently tie up GP appointments without getting rid of people who are properly sick”.

  8. agrees with John B about nthe French system….if you have a problem with your ear you can select an ENT (oto-rhino) doctor of your choice and get a consultqation for a few Euros. Which ncan be reclaimed mostly from your insurance but is not a huge price. Whereas in the nUK, you visit your GP who might have some experience of ENT, takes 3 attempts to get the right treatment at £7 a throw…it also nworks better min the Netherlands, possibly because the doctors are still doctors rather than social workers…it is the Gaitskell heresy all over again! When He imposed a prescription charge and a spctacle charge, that stupid loathsome tosser Nye Bevan called him the antichrist.

  9. As a 75+ year old in Australia I can tell you that the medicare there is basically a second rate vetinary service. Patients are not encouraged to talk or ask.
    The waiting lists are impressive in length and cunning. You may have to go on a waiting list to see a specialist who then will put you on a wating list. Which can extend itself ad lib.

  10. Don’t quite understand comment 7. You pay an ambulance membership/insurance once a year, its about 75 bucks I think and then you can be rescued as often as you like at no extra cost. If you aren’t insured, why shouldn’t you be charged $1000 for the trip, if that’s what it costs.

    The business about emergency departments and credit scores is even weirder. If you are a local or even from the UK you get free treatment in any public hospital department, period. Medicare doesn’t need to reimburse you because you don’t hand over a cent. You don’t even sign a piece of paper to say you came. Private hospitals costs a bit though, perhaps that’s where he ended up. They generally aren’t much better than the public option for emergency care though.

    Now waiting lists for non-urgent surgery are a different problem, and reflect serious inefficiencies, silo mentalities, and lack of information for patients. In reality, I imagine many middle-class people would fork over a few hundred dollars rather than wait three years to have their cataract done, if they knew how the system works, but people just get shunted around. I had a patient who waited three years to have a mole removed. His GP could have done it, probably at no cost to him.

    Unlike the UK (or parts of) though the waiting lists for relatively urgent stuff, such as cardiac bypass are generally manageable.

  11. Oh and people on most pensions are entitled to ambulance transport at no cost to them , at least in my state, even for nonurgent transport.

  12. JB no realtion to John B

    I live in France -10 years.

    Healthcare provision is about 50% private. State reimburses only up to 70% of an agreed scale whether treatment is in a private or public institution.

    Fees outside the agreed scale, such as forfait journalier (18€) a daily additional fee charged by hospitals, is not covered by the State scheme.

    The patient then pays the balance or buys complimentary insurance to cover this from a very competitive market – premiums are tax-deductible.

    People on low incomes, or treatment for chronic diseases and conditions are 100% reimbursed by the State.

    The benefit here, is the health provider, whether private or public, only gets money if patients attend. People do not join waiting lists, they go elsewhere. People do not tolerate bad service or poor treatment, they go elsewhere.

    There is then a financial incentive for health providers to meet market demand, thus competition, thus a system WHO rated No 1.

    The French system puts the patient in charge, not politicians nor self-serving providers.

    Standards in both private and State institutions is equally good.

  13. Pingback: A quick question to those outraged by Phillip Davies.

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