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A Comparison between the French and British Health systems

By FranceInLondon
01/05/2015

Though the Brits have a much maligned health system, according to the Commonwealth Fund’s report in 2014 the NHS outperforms the majority of other western European health systems, including France. It was rated best overall in terms of efficiency, effective care, safe care, co-ordinated care, patient-centred care and cost-related problems. Sadly the report does not tally with the vast number of other publications, not least those produced by the World Health Organisation (WHO), which ranks the NHS leagues below the majority of its Western neighbours.

In 1952, the then British Minister for Health, Aneurin Bevan, wrote: "the essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged”, a principle which continues to underpin the NHS as expressed by the institution’s key moto, that healthcare should be free at the point of use. Thus any British citizen is entitled to free care with the exception of partial contributions to prescriptions, ophthalmology and dentistry.

The health services are divided into four jurisdictions: England, Wales, Scotland and Northern Ireland. Each geographic body manages its own operating budget on an annual basis funded by general taxation. As evinced by the election focus on the NHS and its combined £30bn projected funding gap by 2021-22, consumer demand has far exceeded available resources as technology and pharmaceuticals become more advanced and diverse. Reported inefficiencies in the service have also contributed to accelerating costs. The complicated mechanics, and politics, of resource allocation in a centralised healthcare system have become all the more convoluted for it. As one might expect, economic travails and political posturing have led to a systematic obsession with centralised performance targets (and institutions missing them), not least headline grabbing waiting times and hospital bed availability figures.  

For this reason, though private healthcare accounts for a significantly smaller share of treatment in the UK than it does in most other western economies, it is an ever increasing one. Private organisations currently provide virtually no acute care, little primary care, and are mostly concentrated on outpatient consultations, elective surgery and some forms of mental health care. Indeed, most specialists spend the majority of their time on the NHS while supplementing their income privately. That being said, since the NHS’s inception there has been a well-documented and controversial drive to privatise certain services. Not all parts of the country agree with this. Indeed, the Scottish NHS has actively resisted it and rejected standard economic theory, which supports the idea that privatisation and deregulation are a one way road to promoting greater efficiency. Despite these intra-UK variations, a report published in 2014 by the Nuffield Trust found no indication that any part of the country was outperforming another. However, what all parties agree on is that the fact the UK faces a very real and urgent funding issue for the next decade.  

How does the French system compare? The French have a universal health system funded by compulsory national health insurance, with premiums automatically deducted from salaries. Indeed, approximately 77% of the country’s health expenditure is covered by government funded agencies with premiums centrally set by government, commensurate with income levels. On balance the French government refunds 70% of care costs and 100% of those with chronic conditions. Like the NHS, the current system is a product of its post-war heritage and was founded in 1945. In many ways, the creators of this social insurance model were inspired by the Beveridge Report, which laid the foundations for the NHS in that year, but were met with significant opposition to creating an entirely comparable model given fears that a new system might disadvantage those with existing and preferable arrangements.

In terms of performance, the French system was described by the WHO as “the best performing in the world in terms of availability and organisation of healthcare providers” in 2000. While it spends less than the US on healthcare as a percentage of GDP (11.6% vs. 17.7%), the French have consistently high patient success and satisfaction rates. Nonetheless, healthcare in France is facing the daunting prospect of increasing pharmaceutical and technological costs in addition to unfavourable demographics (i.e. ageing populations), much like the UK.

What there can be little doubt about is the sustainability of the French system relative to the UK’s behemoth. Indeed, since 2002 British patients have actively been offered treatment in France to reduce waiting lists for hip, knee and cataract surgery with the NHS refunding the cost in full upon a patient’s return. Were the rising pressures in British health services to prove insurmountable, France may well see an increasing number of British patients being offloaded by cash strapped and bloated services.

COMMENTS:

01/03/2018 - helen_sheehan said :

I am Irish living in London and I am used to the French health care system because I worked in Paris for years, It has taken me two weeks to have my case referred to by my doctor here to the hospital for treatment and now it will take another month for an appointment. I am in severe pain. I just know that if I was in France my treatment would be much faster and informative.
I appreciate that the NHS is free however this lenght of time is really unacceptable.

19/12/2017 - marie.c.perpen said :

Bonsoir,

Je vis en Angleterre et pour des raisons de santé je me suis retrouvée en arrêt de travail. Ma santé a empiré, il a fallu que je retourne en France car les services anglais ne firent aucune radio et me conseillèrent de nager . Je passerai sur l’état de la pisc8ne publique de Brighton qui en dit long sur le manque d’hygiène . Des mon arrivée en France , des radios sont faites et on constate un état sévère de mon dos et prescrit traitement immédiatement pour alléger de son douleurs avant un traitement plus approfondi.

Donc allers et retours en France , non remboursés , et les soins non remboursés alors qu ils doivent l’être à 100/100. Du coup , je dois économiser sur le minimum versé et donc j’ai beaucoup moins pour manger . À savoir , la pension que l’on me verse ne tient aucunement compte des augmentations du prix de la nourriture . Le prix du beurre est passé au dôuble en trois ans , tandis que la pension versée se base aux taux de l’an 2000, c’est à dire, trois fois rien . Pas de viande ni de poisson, j’en vis comme un bouddhiste apart que l’environnement , les factures , la maladie , ne facilitent pas un état de meditation contemplatif .

Je me retrouve à avoir faim et manquer de la nourriture essentielle . Et n’en plus avoir assez d’argent pour vivre et me soigner , donc bien empêtrée dans le système médical social anglais, lequel donne beaucoup d’emploi de secrétaires et moins pour l’éducation , les docteurs et les malades. Docteurs qui parfois ont passé leur diplôme en Roumanie ....en deux ans .

Si cel’a ne suffisait pas , depuis octobre 2017 la DWP décide de réduire ma pension .donc pas transport pour les soins, pas remboursement , vu que ils demandent une tonne de papiers alors que juste avec la carte europeeene de santé en un clic ils savent très bien tous les soins reçus et quils’sont Remboursables , et maintenant avec zéro argent pour me nourrir .

On me propose la soupe populaire dans un quartier à une heure de marche en hau5 d’une colline , habité par des drogues au crack .

Bravo au conseil européen . Avant lui on pouvait être remboursé .

11/02/2016 - g.pujol33 said :

Bonjour,

Je vis sur Londres depuis presque 3 ans maintenant et il y a 3 semaines j'étais en vacances sauf que j'ai du me faire opérer d'un kyste pilonidale.
Comment fonctionne le remboursement sachant que j'ai un numéro avec NHS?

16/05/2015 - capabilitybbbrown said :

If Uk looked more closely at their poor cousins in France they could learn a lot!!!!!
You can only sustain a product with an element of give and take.You have to pay for what you get!!!!!

06/05/2015 - nipeug said :

So, for a French citizen living in London, do you recommend having a private insurance as a potential back up or can we rely on the NHS only?

06/05/2015 - hs.martin said :

About 4 pars down in the Commonwealth report it said that while the NHS was good at some things it wasn't so hot at actually keeping people alive. Enough said.

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