Lessons from France--'vive la difference'. The French health care system and US health system reform

Abstract

GERMANY, and Canada, maybe England. These countries are where US policy makers look for lessons applicable to reform of the US health care system. Why not France? France provides almost universal coverage with a uniform comprehensive benefit plan that, unlike those in the United States, includes pharmaceuticals, physical therapy, and even medically prescribed spa treatments. Consumers have coverage that follows them from job to job, including any intervening periods of unemployment. Out-of-pocket costs are capped below the level where they could cause financial hardship. There is free choice of office-based physicians and ancillary service providers for ambulatory care. France spent 9.1% of its gross domestic product (GDP) on health care in 1991, similar to Canada (10.0%) and Germany (8.5%) but over 4 GDP percentage points less than the United States at 13.4%.1Yet life expectancy in France at 81.1 years for women and 73.0 years for men in 1991