hello dear students Dr Dinka here with a lecture today on Francis Healthcare System we're going to um see how friends funds its um Healthcare System some of the main features of of this of their system and also why France is number one in healthcare in the world okay in France so today we'll talk about the health system in France and what's very interesting is that um their system is part of a broader social security system that um includes La Retreat retirement um some safety net for um unemployment and other benefits that French citizens have so let's have a look um an in-depth look at the system so the French Healthcare System it's a universal healthcare financed by government national health insurance and I'll talk about how it works in a little bit um going back to uh 2000 when there was an assessment of the world the World Health Care Systems the World Health Organization found that France provided the best overall health care so not just the best best health care System but the best overall health care um in about 2017 friends spent about 11 of their GDP on Health Care um versus um in the U.S that spent about uh 17 so a lot more and it's almost like a contradiction how come um Francis spent France spends Less in um everybody's cover versus the US that spends more and not everybody's covered so um this has to do with uh with history a little bit we're talking about the the government wns of Spain that put in place Universal Health Care coverage and extended uh the coverage to all those legally residents in France um only about three percent three point seven percent of hospital treatment costs are reimbursed to private insurance um and there are also in France public hospitals non-profit independent hospitals linked to the public system as well as private for-profit hospitals so um the provision and management of the Health Care system is um responsibility at the national level um that falls on the Ministry of Social Affairs health and women's rights I said the agenda and however the state has increasingly been involved in controlling the expenditure of the statutory health insurance um Shi so the Shi covers the entire population and according to the common according to the Commonwealth bond that we have an article from that for for this week now the um Shi is broken up into schemes or plan um each of them do not compete with each other and cover a different portion of the population based on occupation the Shi covers most costs of hospitals um Physicians and long-term care and prescription drugs as well patients are responsible for coinsurance co-payments and balance bills for physician charges that exceed covered fees and according to the Health Systems in transition the delivery of Health Care is mixed that includes private fee for service Physicians public hospitals private and non-private hospitals as well as private profit making hospitals so we have a mix and um in this article that we're reading for this week you have the organization of the Health Care system and you see all these different actors that have to um in organizations that have to come into place um for this uh very complex system to happen Okay so as you mentioned the provision of the healthcare is a national responsibility the Ministry of Social Affairs health and women's rights is responsible for defining um the National Health strategy sets and implements government policy for public health as well as the organization and financing of the Health Care system now how does this universal healthcare coverage work so uh was achieved over seven decades by extending statutory health insurance to all employees in 1945 um and retirees in 1945 so right after the second world war um when France had the private um um Insurance Health System the government realized that was not um enough to rebuild the country that was left in Ruins after the German invasion so this is the reason they one of the reasons they provided is um statutory health insurance to to everybody then in 1966 This was um Extended to the self-employed and the unemployed in 2000. in 2000 you also have La Cube maladi Universal um this is the Universal Health carriage coverage or CMU that was created for residents not eligible for Shi although the program required early renewals and entitlement changes whenever a beneficiaries profession or family situation changed after the implementation of CMU fewer than one percent of registered residents were left without Baseline coverage and we can compare this to the United States we have actually have a video that talks about us so the percentage of people in the US not covered is a lot higher than in France in January 2016 the um Shi eligibility was universally granted out of the protection uh protection Universal maladi or also Universal Health Protection Law now you know maladi means disease in French so um it's talking about protection Universal Protection against disease right um but the English translation is Universal Health Protection Law or Puma um to fill in a few remaining coverage uh gaps now the law also replaced and simplified the existing system by providing systematic coverage to all French residents and it merged coverage for person previously covered by the universal healthcare coverage and immigrants covered by the state sponsored health insurance okay so how is this Shi finance and it's very interesting because a lot of it it's based upon payroll taxes that people pay um so that provides about 53 percent of funding now that's different than um in the United States because a lot of people they pay for Medicare so people work in their paid for Medicare which is a system that after people retire but not for the actual um Healthcare System while they're employed unless they're full-time and they're in their company covers them part-time people are not covered by that okay so they have to find um Healthcare elsewhere now um in France with employers paying about 80 percent of the tax and employees paying the rest and contributions are calculated from the actual salaries kept at Euros you have about uh 3 311 Euros per month about four thousand dollars um so National year Market income tax contributes to about 34 percent of funding and they also have very interestingly tax levied on tobacco and alcohol um because in their opinion these are toxic substances that negatively negatively affect the health so if this industries make money from in a way getting people sick by by the tobacco and an alcohol um they should um some of the taxes when people buy those products should go to the health coverage um also uh the pharmaceutical industry and voluntary health insurance company provide about 12 percent of funding the state subsidizes about one percent of funding now coverage is mandatory and is provided to all residents by non-competitive statutory health insurance funds um historically there have been about 42 funds and annual contributions are determined by the parliament the Shi scheme in which workers enroll is based upon the type of employment and unemployed persons are covered for one year after job termination by the Shi scheme of their employer and then by Universal Health Coverage law citizens can opt out of the Shi only rare cases such as when they are employed by Foreign companies and we have here the um or a pay stub in a typical pay stub in France and you can it can have you can see here um this is uh what people earn and then you have all these deductions from their paycheck okay so the first one is what Sante okay so this would be security social invalid uh um complementary capacity so all of this um goes into this is how much they pay from their their paycheck right um for their health insurance then they also have to pay for the threat we'll talk about a threat in the system the pension system next week um and also the so much so this would be the uh um unemployment okay so you see that the first one it's the health insurance that they have to pay for now let's talk about the uh elizopito so we have uh l'hopital the hospitals uh the part there are public institutions account for about 65 percent of Hospital capacity and activity that's a lot more in the uh than in the U.S because we have also a lot more private hospitals in the US um private for profit facilities account for another 25 percent in private nonprofits facilities make up the remainder now all hospitals are inversed under the Shi via the diagnosis Related Group system set by the Ministry of Social Affairs health and women's rights which applies to all inpatient and outpatient admissions it covers all medical services and physician salaries in public and not-for-profit hospitals and in the bundle payment or performance incentives exist now hospitals are reimbursed for certainly expensive and Innovative drugs and devices in addition to this tariff and a list of covered drugs and devices as updated every year by the Ministry of Social Affairs health and women's rights based on semi-transparent criteria of innovativeness price into share of the derg population requiring the Innovative drug or device now public hospitals are funded mainly by the Shi about 80 percent with voluntary insurance and direct pay patient payments accounting further remaining income public and private non-profit hospitals also receive research and teaching grants and Provisions for providing Emergency Services organ harvesting and organ transplantation now some more statistics um eurostat reports that only about 12.7 percent of French residents reported having unmet Health Care needs due to financial reasons as of 2019 that's a big percentage um and the figure is modest comparing to over 25 residents in Portugal and Finland you also you have the freedom in France to choose your doctor it doesn't have to be the in-network doctor like they have um in the states so for example my doctor doesn't work with my current health insurance plan um um my dentist so it's very difficult um because you have to pay out of pocket and it's a lot of money um also you don't need a referral for a specialist so if you have um for example some problems with the heart or uh you can just go to a Cardiologist without the front the primary care doctor referring you now service is covered um the cover benefits under the Shi are defined at the national level by the Ministry of Social Affairs health and women's rights um as we mentioned and these are groups grouped under the national Union of health insurance funds and umbrella organization so the Shi covers the following so first of all hospital care is very important treatment in public or private rehab validation or physiotherapy institutions also covers the outpatient care provided by General Practitioners specialist dentists physical therapists and midwives all maternity care services newborn can children preventative health care up to age four diagnostic services prescribed by doctors and carried out by Laboratories and paramedical professionals prescription drugs medical appliances including durable equipment such as wheelchair proteases and they have been approved for reimbursement and prescribe Health Care related transportation and Home Care now for those people who travel how do you register for French Healthcare if you visit friends see if you lived in France for longer than three months you can register for the French Healthcare via the local CPM ques primer's maladi office and you can find it up on a vmle website if you're employed or employer first register you the French social security system and if you are self-employed you can see another website to get coverage you may need to show certain documents for example your passport valid ID proof of French residence proof of address such as a recent utility bill marriage or birth certificates it's including family members proof of income like Employment contract you also needs to choose a primary care doctor submit on Declaration uh to your insurance before accessing Healthcare in France and once you register you should receive a card vital within a week this is that card vital and it's a green Healthcare green um health insurance card that has your photo and has a chip that contains a lot of information about you as a patient medical history also financial information that you write related to as a patient and you'll need to take your carvital with you to all medical appointments in order to access free health care or claim a reimbursement all right so the fan this is the end of today's lecture hope you find this useful if you have any questions any comments please email me and let me know I appreciate your participation in our online class as always and um hope you have a good week till next thank you merci beaucoup