The French like their health system. There are no waiting lists and women live longer than in any other OECD state except Japan. With a life expectancy at birth of 82.3 years, they live nearly four years longer than Irishwomen. The system is complex but achieves equity, or close to it.
But no system is perfect. The life expectancy of a Frenchman (74.6 years) ranks 14th in the OECD, though it's over a year more than that of an Irishman. And the French are concerned about how to control healthcare spending, which consumes more than nine per cent of GDP, the same proportion as that of Canada, and exceeded only by the US, Switzerland and Germany.
A 1997 Eurobarometer survey showed two-thirds of the French population were fairly satisfied with their healthcare, compared with 40 per cent in the UK. A recent OECD study described the French system as delivering "high-quality services, with freedom of choice and generally no waiting lists for treatments. Access to medical services is equal among the population and people can get the treatment they need irrespective of their social status or work situation."
The mortality rate among Frenchmen had little to do with the health system but was explained by a high incidence of AIDS and violent deaths from suicide and road accidents - tobacco and alcohol also played a role.
The absence of waiting lists in France was examined by Labour TD Liz McManus in a report for a Joint Oireachtas Committee earlier this year. She noted: "France has avoided waiting lists by having overcapacity built into the system." France has above the European average of acute-care beds. Bed-occupancy rates run at around 75 per cent, compared with an average 95 per cent in Dublin's acute hospitals. Surgery is planned under a booking system, in which the patient is given a date for surgery but this may involve a few months' wait.
French healthcare is funded through the social-security system established in the mid-1940s. Workers and employers pay for healthcare through social-insurance contributions. This compulsory social insurance covers 99.5 per cent of the population. The contributions are channelled into 18 social-insurance funds, the largest of which covers four-fifths of the population and are governed by union and employer representatives.
Patients pay GPs and specialists outside hospitals directly, for which they are reimbursed by social security for some but not all of the cost, the remainder being covered by supplementary insurance purchased from private insurers or non-profit mutuelles. In practice, almost all healthcare is covered by insurance. Working households spend an average 20 per cent of their gross income on health. The poorest households do not have to pay fees up front under a universal health-insurance scheme introduced last year. The system is bureaucratic, with administration costs accounting for more than 10 per cent of the funds' outgoings, mostly due to "the refund of endless small sums paid directly to doctors by their patients".
French hospitals can be publicly or privately run. Public-hospital staff have the status of civil servants. Hospital doctors are salaried, with incomes ranging from 295,000 francs (£35,420) to 535,000 francs (£64,235). They may conduct private practice in public hospitals, although it must not exceed 20 per cent of their normal working week. Patients may pay privately for faster access but, given the absence of waiting lists, there is no apparent concern that this causes two-tier access. As there is competition between abundant doctors, the volume of procedures offered and of medicines prescribed is high. France has the world's highest per-capita consumption of pharmaceuticals.
Following three consecutive years in which income from social security failed to match expenditure, causing healthcare to require greater funding from general taxation, the French government decided in 1995 to reform the health system. When fears were provoked for social-security pensions, three weeks of public protest followed and paralysed Paris.
The 1996 JuppΘ healthcare reform required amendments to the constitution so that parliament could set targets for spending and reimbursements. As targets have been overrun, since last year the largest health-insurance fund has been required to report to government on targets each four months.