Caitlin Welch

The French Healthcare System

The Douglas Andrews Memorial Grant allowed me to spend time studying the French healthcare system while I was in Rouen, France. To learn about the system, I spent 6 days interning at Planning Familial (the French version of Planned Parenthood), traveled to Nice to see how the hospital was organized, and went to Paris to speak with a woman who worked at the American Hospital of Paris.

It was at Planning Familial that I learned the most about the healthcare system. The physicians there explained many of the intricacies of the system, starting with the education system. Medical school starts for students at the age of 18 and is open enrollment. Anyone who can pay is welcome. The cost of a year is approximately 230€. At the end of the first year there is a "grand concour" which is an exam that determines if you can proceed on to the second year of medical school. It is possible for students to repeat their first year of medical school, but if they fail the "grand concour" the second time, their medical school experience is over. Only 10% of each first year class passes the "grand concour." Medical school is a six year program and is generally followed by three years of specialization.

Every person that is a part of the Sécurité Sociale is given a social security card that is used for all medical expenses; as a part of Sécurité Sociale, twenty-five percent is taken from everyone's income to contribute to the funding for universal health care. Seventy percent of medical expenses are covered by the state; the remaining thirty percent is either covered by the individual or by a mutual insurance. If the medical issues are serious: surgery, long-term hospitalization, etc., the state covers the entire cost even if you do not have a mutual insurance plan. Mutual insurances cost about 45€ a month for one person, or approximately 100€ a month for a family; though it depends on the insurance and the situation. A visit to a general physician costs 22€. There is also a benefit available for those who cannot afford to pay for a mutual insurance plan, called CMU (Couverture Maladie Universelle); for example, college students can apply for CMU.

One of the problems with the system, that the physicians at Planning Familial mentioned, was abuse by patients. Patients go to the doctor's office every time they have a problem because it is free. Also, many doctors do not keep good records. However, despite these problems, one of the doctors at Planning Familial said that she believed the French healthcare system provided the citizens with a feeling of solidarity. The French healthcare system is number one in the world.

Speaking with the woman at the American Hospital in Paris gave me great insight about the system. According to Rebecca Allaigre, generally French doctors are very offended when patients have questions and have a much stronger belief that they are "all knowing" compared to American doctors. She also said that nursing, as a profession, is not nearly as well respected in France. Nurses are not allowed to make as many decisions. Doctors spend more time with their patients, especially in clinics where nurses are not used as frequently.

In France, the focus is more on prevention and early diagnosis than in the US because the care is available for everyone. In France, house calls are common practice. House calls are more expensive, though generally still covered to some extent by the Sécurité Sociale.

All citizens are allowed to choose their doctors, while understanding that more expensive doctors may not be entirely covered by the Sécurité Sociale. It is required, for government reimbursement, that all patients have a French family doctor who can then refer them to specialists. When a patient visits a doctor, he/she pays and is then reimbursed by the state.

The healthcare system, though most people believe it is entirely public, actually has both a private and public sector. Doctors in the public sector are generally less expensive and are more likely to be covered to a greater extent than doctors in the private sector. If immigrants go to the hospital for care, the government covers the cost if they have no insurance. Rebecca also said that although malpractice lawsuits occur in France, they are much less common than in the United States.

My experience learning about the French healthcare system was phenomenal and gave me a new outlook on our system and ways we could possibly improve. It is a great idea to take advantage of your time abroad and learn something in particular that you would have never had the opportunity to do without a research grant.