Between the Healthcare Systems: France and the United States
Despite having the most expensive healthcare system in the world, the U.S. is not on top of the list of the best healthcare systems created by the World Health Organization. However, in 2000, this position was occupied by France, the healthcare expenses of which are incomparable to those of the U.S. (Rodwin, 2003). As a result, the healthcare system of France can be viewed as a standard of quality, which may be used for referencing. It justifies the fact that this country was chosen for the conduction of the comparative analysis. Therefore, the following work is dedicated to the comparison of the healthcare systems of the U.S. and France.
Health Statistics and Costs
The life expectancy in the U.S. is 74.4 years for men and 79.8 years for women. The mortality rate is 8.25 per 1,000 people while the infant mortality is 6.5 per 1000 live births. The primary causes of death are heart diseases (29%) and cancer (22.9%) (Holtz, 2008). The U.S. is the owner of the most expensive healthcare system in the world. According to current estimates, the costs of healthcare in the United States account for 16% of GDP. It is expected that by 2017, they will increase by 6.7%. Considering that the majority of these costs are covered by the state, a strain on the federal budget is quite possible in the future (Henderson, 2015).
In France, the life expectancy is relatively higher – 77.7 years for men and 84.3 years for women, which is the highest in the EU. The mortality rate is lower than in the U.S., reaching 6.7 per 1,000 people. The infant mortality is also very low – 4.9 per 1,000 live births. As in the U.S., cardiovascular diseases and cancer are the main causes of death in France but the percentage of deaths because of these diseases is significantly higher (33.5% and 27.3% of all deaths respectively) (Henderson, 2015). The healthcare costs are significantly lower than in the U.S. but they still are ahead of the pace of development of the national economy. Since 1965, spending on healthcare has increased from 5.25% to 9.9% of GDP, which is the highest rate in the EU. Over the last 20 years, there have been attempts to increase these costs by increasing revenues or at the expense of the national health insurance system but this did not give any significant results (Henderson, 2015).
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Health Care Financing
The U.S. health system is financed by the public and private funds. The private insurance policies cover about 36% of the healthcare costs, 15% are paid directly by the individuals, 34% – by the federal government, 11% – by the state governments or local authorities, and 4% – by the other private funds. In most cases (59.7%) the private health insurance is provided by the employers. However, the costs for such insurance have increased by 78% since 2001. At the same time, the employees provided with insurance sometimes have to pay for medical services in the form of various surcharges and deductibles (Henderson, 2015).
On the contrary, in France, almost 74% of the total health care costs are covered at the expense of the national health insurance system. At this stage, there is a decrease of the cost’s share. Mutual insurance organizations and private insurance companies cover 6.8% and 5% of healthcare costs respectively. Less than 3% are compensated at the expense of general taxation while the remaining 13% are covered by the patient co-payments. Unlike the U.S., the levels of such co-payments have remained stable over the last 30 years, which makes them an important tool for cost containment of health care in France. The financing of the main mode of insurance is provided by insurance contributions from employers and employees. Currently, the level of payments of insurance premiums amount to 12.8% and 6.8% for employers and workers respectively. Pensioners pay contributions at lower rates (Rodwin, 2003).
In the U.S., the responsibility for the health of the nation is carried out by the United States Department of Health and Human Services, headed by the Secretary that reports directly to the President. The Department consists of ten officials in the different regions of the country. It should be noted that in the U.S., the Department of Health plays an insignificant role due to the minor proportion of state involvement in the industry. Among its primary objectives are the control of the medical system and social programs, the monitoring of medical science and the situation in the field of health and social welfare. The following units within the Department are directly involved in the process of addressing the healthcare problems – the Public Health Service and the Department of Health Care Finance. Besides them, the governing functions are partially carried out by the special units of the Ministry of Labor, the Agency for Environmental Protection, and other governmental departments (Henderson, 2015).
Unlike the U.S., the French government plays a leading role in the process of controlling the healthcare system. It is responsible for the health system as a whole, provides social protection, supervises the work of organizations that fund the industry, and also deals with the organization of training of health workers. At the local level, there are 22 regional departments of health and social affairs. Their main task is to plan for health and social care as part of the annual budget, as well as monitoring the implementation of the plan of care (Rodwin, 2003).
Health Care Personnel and Facilities
In the U.S., there are 320 hospital beds per 100,000 people, which is below the average level across the world. Thus, it is possible to say that currently, there is a shortage of the healthcare facilities in the country. As for the personnel, there are about 26 physicians for 10,000 citizens in the U.S. (which is rather low) with about 52% of them being self-employed. Moreover, according to the American Medical Association, in the following 15 years, the U.S. will experience a shortage of doctors due to the aging population and the unchanging number of graduates from medical schools. In addition, there is a shortage of the registered nurses (98.2 per 10,000 people), which is expected to grow to 260,000 people by 2025 (Henderson, 2015).
According to the current estimates, there are 734 hospital beds per 100,000 people in France, which is twice more than in the U.S. In 1993, it was planned to reduce their number but the initiative failed due to the resistance of the population. Currently, there are 34 healthcare practitioners for 10,000 people in France. However, there is a shortage of the qualified physicians in the rural areas of the country. Similarly to the U.S., most doctors are self-employed. At the same time, just as the U.S., France experiences a considerable shortage of nurses, currently having 93 of them per 10,000 people (Henderson, 2015).
Access and Inequality Issues
In the U.S., up to 16% of the population is not covered by medical insurance. Many of these people cannot pay for the treatment and are delaying it, which ultimately leads to the increased healthcare costs. In particular, about 30.6 billion dollars are spent by the state for medical support of its uninsured residents, covering 80-85% of the uncompensated medical care by means of grants, various direct payments, tax subsidies, and payments under Medicare and Medicaid programs (Henderson, 2015). At the same time, healthcare services are distributed unevenly, with underrepresented minorities (Latinos and Native Americans) having fewer opportunities to access certain medical procedures (Holtz, 2008).
In France, the equitable access to health care is guaranteed by the national health insurance system, which is a part of the compulsory social security. The national health insurance system covers 99% of the population. The insurance system has various control modes, depending on the occupation of the insured person, with the basic mode covering about 80% of the population. The health insurance compensates for the cost of a wide range of diagnostic tests and medical services during outpatient and inpatient treatment. Unlike the U.S., medical assistance to the poor is provided by charity organizations rather than the federal budget. However, despite these facts, social inequality in France is quite noticeable. In particular, the risk of premature death is higher among the low-income population groups and the individuals engaged in physical labor (Henderson, 2015).
It is possible to say that despite the shortage of personnel, the healthcare system of France is more efficient than that of the U.S. It is so not only due to the higher life expectancy and lower mortality rate but also the accessibility of care. As was mentioned before about 99% of the population of France is covered by medical insurance, and the costs spent on the healthcare are significantly lower than those in the U.S. Moreover, the strict governmental control and the stable system of co-payments allow containing the healthcare costs – something that is not present in the U.S. healthcare system.