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A Comparison between the French and British Health systems
Though the Brits have a much maligned health system, according to the Commonwealth Fund’s report in 2014 the NHS outperforms the majority of other western European health systems, including France. It was rated best overall in terms of efficiency, effective care, safe care, co-ordinated care, patient-centred care and cost-related problems. Sadly the report does not tally with the vast number of other publications, not least those produced by the World Health Organisation (WHO), which ranks the NHS leagues below the majority of its Western neighbours.
In 1952, the then British Minister for Health, Aneurin Bevan, wrote: "the essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged”, a principle which continues to underpin the NHS as expressed by the institution’s key moto, that healthcare should be free at the point of use. Thus any British citizen is entitled to free care with the exception of partial contributions to prescriptions, ophthalmology and dentistry.
The health services are divided into four jurisdictions: England, Wales, Scotland and Northern Ireland. Each geographic body manages its own operating budget on an annual basis funded by general taxation. As evinced by the election focus on the NHS and its combined £30bn projected funding gap by 2021-22, consumer demand has far exceeded available resources as technology and pharmaceuticals become more advanced and diverse. Reported inefficiencies in the service have also contributed to accelerating costs. The complicated mechanics, and politics, of resource allocation in a centralised healthcare system have become all the more convoluted for it. As one might expect, economic travails and political posturing have led to a systematic obsession with centralised performance targets (and institutions missing them), not least headline grabbing waiting times and hospital bed availability figures.
For this reason, though private healthcare accounts for a significantly smaller share of treatment in the UK than it does in most other western economies, it is an ever increasing one. Private organisations currently provide virtually no acute care, little primary care, and are mostly concentrated on outpatient consultations, elective surgery and some forms of mental health care. Indeed, most specialists spend the majority of their time on the NHS while supplementing their income privately. That being said, since the NHS’s inception there has been a well-documented and controversial drive to privatise certain services. Not all parts of the country agree with this. Indeed, the Scottish NHS has actively resisted it and rejected standard economic theory, which supports the idea that privatisation and deregulation are a one way road to promoting greater efficiency. Despite these intra-UK variations, a report published in 2014 by the Nuffield Trust found no indication that any part of the country was outperforming another. However, what all parties agree on is that the fact the UK faces a very real and urgent funding issue for the next decade.
How does the French system compare? The French have a universal health system funded by compulsory national health insurance, with premiums automatically deducted from salaries. Indeed, approximately 77% of the country’s health expenditure is covered by government funded agencies with premiums centrally set by government, commensurate with income levels. On balance the French government refunds 70% of care costs and 100% of those with chronic conditions. Like the NHS, the current system is a product of its post-war heritage and was founded in 1945. In many ways, the creators of this social insurance model were inspired by the Beveridge Report, which laid the foundations for the NHS in that year, but were met with significant opposition to creating an entirely comparable model given fears that a new system might disadvantage those with existing and preferable arrangements.
In terms of performance, the French system was described by the WHO as “the best performing in the world in terms of availability and organisation of healthcare providers” in 2000. While it spends less than the US on healthcare as a percentage of GDP (11.6% vs. 17.7%), the French have consistently high patient success and satisfaction rates. Nonetheless, healthcare in France is facing the daunting prospect of increasing pharmaceutical and technological costs in addition to unfavourable demographics (i.e. ageing populations), much like the UK.
What there can be little doubt about is the sustainability of the French system relative to the UK’s behemoth. Indeed, since 2002 British patients have actively been offered treatment in France to reduce waiting lists for hip, knee and cataract surgery with the NHS refunding the cost in full upon a patient’s return. Were the rising pressures in British health services to prove insurmountable, France may well see an increasing number of British patients being offloaded by cash strapped and bloated services.