[Music] there's a saying I'm quite fond of although I'm not sure who first pinned it the French love their Health Care system and change it all the time here in America we hate ours but refuse to touch it there's some truth to that there's also a lot that much of the world could learn from France their Health Care system is the topic of this week's Healthcare triage toward the end of World War II the French realized that their country was in pretty bad shape there was little chance that the shattered private sector was going to be able to take care of all the people who might need Healthcare in the next few years so France established a system of national health insurance in 1945 the system is ironically for those of us in the United States known as Social Security everyone in France must pay for mandatory health insurance insurance is obtained from nonprofit funds there really isn't any competition and there really aren't many choices there are five known as general independent agricultural student and public Serv service One Fund alone covers almost 85% of all people in France I'll give you three guesses which one it is they all have pretty much the same benefits and the same reimbursement the only people who don't fall into one of these five funds are people who've never worked or aren't covered by other sources for those people the government has its own plan financed by taxes that reimburse is better than the other funds for people like the very poor who can't make out of pocket payments these funds are financed largely by the public more than 40% of healthcare spending is financed by payroll taxes and about a third from income taxes the rest comes from tobacco and alcohol taxes some transfers from other branches of Social Security and a small amount from State subsidies altogether this covers more than 3ars of All healthc Care spending this insurance covers a lot inpatient and Outpatient Care Specialists dentists midwives diagnostic tests and services prescription drugs medical devices mental health even Health rated Transportation stuff we'd never consider covering in the United States as included things like Homeopathy house calls amazing maternity benefits and even Child Care Social Security covers somewhere between 70 and 80% of costs leaving the remaining amount in individual's hands but there's also voluntary health insurance provided by private insurance companies or from the government for those who are poor this insurance covers many of the costs that Social Security doesn't more than 90% of the French have voluntary health insurance plans mostly through their jobs almost 70% of primary care physicians and more than half of Specialists are self-employed again France is not socialized medicine about 2third of hospital beds are owned by public or nonprofit groups the other third are owned by individuals or corporations and are totally for-profit businesses doctors make much less than those in some countries maybe a third of what doctors do in the United States but they get medical school for free and they pay nothing from out practice insurance and if they agree to charge government approve rates they get some of their social security taxes wave two so it's not as much of a difference as it first appears funds and budgets are set by the Ministry of Health which also regulates the number of hospital beds what equipment is purchased and how many medical students are trained the ministry also sets the prices for procedures and drugs and defines priority areas for future focus and spending it oversees agreements between Social Security and unions which represent Physicians doctors can choose to work outside of these agreements though and charge more patients have total choice of where they go for care and who they see because prices and reimbursement are set at a high level they can go pretty much anywhere there is some level of gatekeeping where patients pay less if they get referrals to Specialists before they go there but those referrals aren't to specific facilities or Physicians they're just permission to choose what they want most people in France pay very little themselves for their health care after insurance kicks in doctor visits can cost € or less a hospital stay can run as little as €18 a day mostly for the room and board prescription drugs are like half a Euro all of these together are capped at €50 a year and inter aspect of the system is that copays are regulated by sickness people who have chronic conditions have all their copays waved in other words people who use the most care in general pay the least France also allows pretty impressive access for instance it guarantees that cancer patients can get any drug they want even expensive or experimental ones as I said in the beginning of this episode the French love their system in international surveys it always kicks butt in terms of satisfaction it also crushes the competition in terms of quality in almost every International comparison no matter what methodology you use France comes out near the top if not in first place I've never met and rarely read anyone who has a bad story to tell about their care there the knock against the French system is that it's expensive and it is compared to lots of other countries it's $411 per person is well above the oecd average of $3,322 in 2011 but it's nothing compared to the $858 we spend in the United States with respect to spending as a percentage of GDP France is near the highest in the world at 11.6% that's beaten only by the Netherlands at 11.9% and of course the United States at 17.7% so everyone else in the world may have a genuine case when they claim that France is too expensive but I laugh at anyone in the United States that says so genuinely Universal coverage comprehensive benefits complete freedom of choice of provide ERS top in the world outcomes there's a good case to be made that the French have the best healthare system in the world