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Tuesday, August 24, 2010

AN INTERVIEW WITH FRANCE'S PRE-EMINENT SPECIALIST, ACADEMIC AND PRACTICAL, ON THE FRENCH HEALTHCARE SYSTEM AND SOME COMPARISONS WITH THE USA'S

Today's Buggy Post Is, As the Title Says,

. . . A follow-up to yesterday's prof bug stuff left on August 23: click here for it.   The interview in question is with Professor Didier Tabuteau, a socialist who organized the ministries of two socialist ministers for healthcare and social security in the early 1990s.  He currently holds a chair in the two subjects at Sciences Politiques in Paris and is probably, given his practical and academic experience, the leading expert on them in France. 

The Interview Will Follow in a Second

Note meanwhile that the interviewers were apparently other doctors and dentists in the French system, the resulting print copy then published in Le Monde in early January 2010.  Prof bug translated the French and posted it in clear, colloquial English at Economist's View, where it was removed by the moderator . . . maybe, who knows, because it was too long.  A shame though.  It was in response to several critics in the relevant thread there, a couple living in France, who thought prof bug had gone (as one put it) ballistic. 

No matter.  The debate between buggy went on yesterday evening and again this morning, so even if you read the thread at Economist View linked to on Sunday (August 22nd, 2010), you might still find it beneficial --- and a source of some giggling entertainment --- if you click on the "Show More Comments" bar on the first page of the Economist's View thread and then run a buggy search for several bugged out posts and exchanges.

  

Tuesday, January 12, 2010

Didier Tabuteau: "The protection is even less expensive it is universal" LEMONDE.FR  11.01.10  5:23 p.m.   http://notesblanches.blogspot.com/2010/01/didier-tabuteau-la-protection-est.html

PRIVATIZATION:

Lulu: Is the French health system being privatized in the American manner.?

Didier Tabuteau: No, not in the American sense, for the basic coverage remains the same for everyone. But there is a gradual privatization of routine health care expenses, that is to say, not involving serious diseases, diseases of long duration (ALD), and hospitalizations.

For routine care of this sort, the reimbursement rates [by the state healthcare system] seem to be about 55%, according to our estimates.  This overall rate should be officially released and followed in the healthcare system.  In this way, it should serve as a major indicator for assessing the health coverage of real people who have no serious illness --- which is to say, the vast majority of the population.

DEFICITS AND GROWING HEALTHCARE EXPENSES

Click on the "Continue" button below.

Guest: Social Security is not a profit-run system, isn't it?  As such, isn't it necessarily going to experience deficits.  Why should they be a problem?
Didier Tabuteau: First, I do not think that because it is non-profit, the social security system {buggy: health-care system?] should be cumulating fiscal deficits.  In the past, it even occasionally enjoyed some surpluses. . . .  

JLC: Why not consider that the increase in health spending is good news (just like growing food consumption or more cars) as a sign of economic health? And so why shouldn't the healthcare spending not be encouraged instead of it being seen as a cost-threat that needs to be contained?

Didier Tabuteau: Yes, rising health care spending is actually good news when we can be sure that these expenditures are used as best as [medically] possible. I am convinced that health spending will continue to increase and they are a great investment for the country.
And yet  only if we control effectively the increased spending can we assume that it is being used efficiently to the max.  Our watchword should be to contain health spending for spending more.

CAUSES OF HIGHER HEALTHCARE FEES BEYOND STATE-LEVELS OF COMPENSATION TO PATIENTS?

Cyril: Why are the fees charged by healthcare providers to patients  --- [buggy: above and beyond state compensation] --- growing more and more?  If this continues, might we not reach a situation in our large cities where the patient will have to pay more or have a long wait for an appointment without paying extra fees?
Didier Tabuteau: Even now that's a real risk.  The fees in excess of state compensation started in 1980. At first, doctors weren't favorable to higher frees.  Gradually, though, more and more doctors chose to charge whatever they wanted in the free-market part of healthcare before that section was closed in 1990  No matter.  Since then, several ways have emerged for doctors again to charge whatever they want or can.

It is a dangerous development.  On the one hand, it does free the social security system [that supports the healthcare payments by the state]  from picking up the costs of these growing fees; but, on the other hand, this development destroys ["detruit"] the cornerstone [of our healthcare system] ---binding rates. Continuing economic pressure on health insurance [bought separately by French patients in the private market] may explain this trend --- but not entirely.  The growth of extra fees beyond state-rates reflects as well political choices, such as diverse rates of fee-coverage and deductibles that can be charged to the patient. 

THE REFORMS OF THE HEALTHCARE SYSTEM SINCE 2004 AND THE RESULTING DIVERSITY F FEES AND DEDUCTION AS WELL AS THE GROWING DEVELOPMENT OF SUPPLEMENTARY PRIVATE MEDICAL INSURANCE

padupe: How do you explain that the reforms of the health system make it more opaque  [for providers and patients]? 

Didier Tabuteau: I think there are good and bad reasons for such opaqueness [complexity?] 

 First, we wanted to adjust pricing to deal with individual health problems: for instance, to take into account children's age in the rates of compensation for medical consultations, or the various surcharges for Sundays or holidays, or night.  All this may be understandable.  Even so, this growing diversity and complexity in the healthcare system's coverage may ultimately threaten the social consensus that surrounds it.
In particular, this growing diversity of fees and deductions in the state health-care system makes it harder and harder to enforce basic rates.  If it continues, it will clearly promote the development of supplementary [private medical] insurance in the country.

PROBLEMS OF STATE-REGULATION OF HEALTH-CARE PROVISION

 jlc: Do you think a main problem [in the healthcare system]  is not just the growing fiscal deficit but also the regulation of health care provision?  Doesn't the growing rate of private healthcare insurance for profit make it harder for the state to regulate healthcare that is simultaneously state-run as a public service

Didier Tabuteau: I do believe that [effective] regulation of the supply of care is the major lever to help balance the system.  [buggy: the context suggests that effective regulation of supplying medical care to patients refers to rationing it, but prof bug could be wrong.]

Note though.  The growth of a private healthcare system alongside the state-run system is a good thing: it helps diversify overall healthcare and provides more flexibility and responsiveness. But it is true that this development side-by-side of two systems, private and public, complicates regulation. Even so, it's better to have a more complicated challenge of effective regulation than to see the strengths of our healthcare system in France erode [buggy: due to rising costs and deficits etc

WHAT SHOULD THE STATE HEALTHCARE SYSTEM MAINLY CONCENTRATE ITS EXPENDITURES ON?

jlc: Do you think the state healthcare system should focus only on heavy risks, the rest being covered by private insurance?  Or do you think that the logic of complementary current is effective?

Didier Tabuteau: I think we must avoid at all costs that Social Security focuses solely on heavy risks.

Of course, these major risks should be fully supported, but state reimbursement for routine care is the basis of our country's consensus about healthcare.  Such state-based healthcare insurance [through the social security system] can alone ensure solidarity and equality between the healthy and the sick in French society. 

If Social Security covered only "big risks", I am convinced that this pillar of the social-contract would be directly threatened. Those who are younger or in better health might be tempted not to be covered in this state system at all . . . or prefer private insurance with lower premiums . . .

Eric: Why does the medical profession (doctors, pharmacists) appear to favor the extra-fees and deductions demands of patients instead of effective regulation of the state's rates?

Didier Tabuteau: It varies over history, their role on this score.   In the past, health-professionals sometimes favored close regulation of fees.  This is less so the case since 2004, when the "empowerment" of the patient was initiated. 

I think the regulatory system should be based on co-management of health insurance by the government, credit insurance, the health professions and patient groups. It's far from that situation.

  

FURTHER COMMENTS ON THE GROWING CO-EXISTENCE OF PRIVATE AND PUBLIC HEALTHCARE SYSTEMS

Jeremy: Basically, doesn't the basic problem of Social Security's state-run healthcare system derive from being a hodge-podge mixture private and public healthcare systems, rather than being 100% eitherone or the other?.

Didier Tabuteau: I think the question would arise if one were to build a system from scratch.

 But our health insurance has developed .since 1928 and especially since 1945, as a joint organization for professionals in healthcare  institutions and hospitals, as well as two levels of funding. I think that even if the organization is complex, it has long helped develop a health system accessible, open to medical progress, and relatively egalitarian. To replace this mix with a different system .might open the way for full privatization, even if unintended, of overall healthcare. If we reform the present mixture, we should be able to deal with the growing medical challenges of the next 20 years. .

FRENCH MEDICAL RESEARCH AND THE FUTURE OF THE STATE-RUN SOCIAL SECURITY SYSTEM OF HEALTHCARE INSURANCE

Verley:  Do the funds of our medical labs go hand-in-hand with the health of the French people?

Didier Tabuteau: The funds available to .laboratories do not depend on the health of the French or their consumption of pharmaceuticals... I think more seriously than the regulation of drug expenditure should be as rigorous as for other sectors in health spending. There is undoubtedly much work to do.
Anissa: Finally, is the existing system of social-security healthcare .obsolete now?
Didier Tabuteau: I think, on the contrary, it is a foundation that will be increasingly important in the future.  Public insurance for sick people in our country is essential for the confidence of the French in our healthcare systems and the expansion of our [healthcare] profession [business?].  ....

Benedict: Aren't we  .the biggest consumers of healthcare . in Europe?
Didier Tabuteau: We have a healthcare system that spends 11% of GDP, the highest in Europe.. But when you look at the expenditure per capita, we are at a good point in overall expenditures. So our reputation for high consumption of care is more collective than individual.
That said, do not forget that our country has good health indicators, including life expectancy at birth or at age 60. And international assessments show that the quality of care for diseases for which comparisons were made is also very satisfactory. Our weakness shows up much more in .premature mortality, particularly related to fatalities especially on the road, smoking or alcoholism. It also shows up in the inequalities in health between different social groups.

So I think the challenge is to do more to convince people to change their behavior and overall patient-care.  ...

satazur: How is it that there are dentists as well as doctors who refuse state-rates of fee-compensation?   Is it because they do not earn enough money?
Didier Tabuteau:  The problems here don't show up in any denial of care by primary doctors.  The real problem --- marked and regrettable --- shows up in certain medical specialities, primarily for practioners in sector 2. The reasons are numerous, but it seems clear that the economic motive is very important.  Doctors, after all, are free to charge rates for patients in that sector.
marie-Is there a model-country for us to imitate in healthcare

Didier Tabuteau: There are reference countries like Sweden, which have managed to reconcile a relative equality of access to care and control health costs.

But we must avoid any temptation to implement a system in another country.  Overall health is deeply rooted in national habits and behavior --- in our socio-cultural nature.  And so importing another country's healthcare system is very difficult. I think the French system still has the resources to remain a reference-system for others, provided .

Laure Belot and Cécile Prieur