by Nashville Health Care Council | Apr 12, 2013

Published April 12, 2013 on NashvillePost.com

by Aileen Katcher

Editor’s note: This is the fifth in a series of posts this week from the Nashville Health Care Council’s International Health Care Mission to Paris. To view others, click here.

As we ended the last session of the Council’s international mission in Paris on Friday, delegates reflected on the learning opportunities offered to them over the past five days. We began the trip anxious to understand what France was doing to achieve its strong outcomes and low health care GDP. Many insights were gained, but, as in so much with health care, there is no simple answer.

We assumed quality measures would help us understand the country’s health standings, but were surprised to discover that little data is available in this area. There isn’t standardization across the system and we found no organized effort to collect data. Most Council delegates agreed that since patients who want reimbursement for doctor visits did use their general practitioner to monitor their care, there is an understanding of the importance of primary care in France, something the U.S. has been emphasizing more only in recent years.

We discussed France’s firm commitment to freedom of choice. But while choice is there in theory, we had questions about whether there were true choices throughout the country. In more rural, economically depressed areas, there is an access problem and lack of providers. Even in the urban, wealthier areas, private hospitals appeared limited in the services they were allowed to offer.

Among the experts we spoke with, opinions were varied as to the degree of satisfaction with the system. There is not widespread commitment to wellness or prevention, nor an understanding of their relationship to controlling health care costs. And, although the country doesn’t appear to have the large obesity problem we do in the U.S., it was noted that many of the health care professionals we came into contact with were smokers – including one who talked about the importance of smoking cessation.

There is no doubt that the French have a better system for the poor to access and receive health care. And perhaps because of good prenatal care for all expectant mothers, France does have a lower infant mortality rate than the U.S.

There is definitely an entitlement mentality here. And, without doubt, in France, it is believed that health care is an inalienable right.

The differences between the French and American systems are complex and cultural. We are at different stages and, as one speaker noted, it appears that the French are shifting closer to the U.S. system while health care reform in the U.S. is shifting us more towards the current French system