Originally Published September 2000
A NOTE FROM THE EDITOR
Another French Paradox?
France has the best healthcare system in the world, according to criteria used for a global healthcare analysis conducted by the World Health Organization. The United States, which spends a higher portion of its gross domestic product on healthcare than any other country, ranks 37th. This report may have raised a few eyebrows when it was published in June, but it didn't surprise me.
I lived in France from 1971 to 1985, spending part of that time as a struggling student, the remainder as a struggling wage slave. Short on disposable income, I often had to deprive myself of the finer things in life—which is especially difficult in a country where they are in such abundance—but I never had to worry about not being able to afford to go to the doctor or to buy medication. Living in the United States under the same circumstances, it would have been almost impossible for me to gain access to quality healthcare, unless I were willing to pay for private health insurance that I could ill afford. How well people of varying economic status are served by the healthcare system and the extent of health inequalities are among the factors that the WHO considered in establishing its ranking, areas in which France understandably scored very well. (The remaining indicators are the overall level of a population's health; the overall level of the health system's responsiveness, which the WHO describes as a combination of patient satisfaction and how well the system performs; and how equitably funding is raised and distributed.)
From a consumer's point of view, the French recipe for universal healthcare coverage may not be perfect, but it's superior to the alternatives. For many economists, however, it may not be sustainable.
Additional revenue will be needed to continue funding this generous healthcare package, and with municipal and presidential elections in the offing, raising taxes is probably not an option for the current government. Deficit spending? In the era of the euro, there is precious little room to manoeuvre on that front.
Given the limited choices, the government has not been averse to asking industry to shoulder part of the burden. The TIPS pricing list for medical devices, noted for its opaque decision-making process and glacially slow acceptance of innovative technologies, has been a constant source of frustration for device companies. Few will mourn its passing—the draft law that will substantially modify the regulation of medical devices in France is due to be implemented in late September 2000—but until more details emerge about the new system and we have seen it in practice, it may be wise to suspend judgment.
When it comes to state-of-the-art technology, industry rightly cautions, France falls short in ensuring patient access. This point was forcefully made in a report titled Medical Technologies in France (see story in the September 1999 issue of EMDM). According to this study authored by Jacques Biot of JNB-Développement S.A. (Paris), the nonreimbursement of technologies such as implantable defibrillators has resulted in low market penetration for these devices. Again, there is some optimism that the new regulatory structure will be more responsive.
I am a staunch supporter of WHO recommendations, notably that countries should make every effort to extend health insurance to as large a percentage of the population as possible. And I wholeheartedly agree with the report's finding that the "impact of failures in health systems is most severe on the poor, who are driven deeper into poverty by lack of financial protection against ill health." I also believe that the device industry is entitled to a fair return on its investment.
Balancing consumer, government, and industry interests is a tall order. Can France find the magic formula? To my mind, there is cause for optimism. After all, this is a country that flouted conventional wisdom by establishing the 35-hour workweek, and found a troisième voie paved with a robust economy and declining unemployment figures.
Work less and prosper? It's the latest—but maybe not the last—French paradox.
Norbert Sparrow
Editor
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