COMPARED QUALITY OUTCOMES OF THE AMERICAN AND FRENCH HEALTH SYSTEMS
American and French health system are often juxtaposed as “contrasting cases” at two opposite ends of the health care spectrum. France is a model of statutory national health insurance (NHI) offering universal coverage via a single payer, in contrast to the US system with 9 per cent of the population still uninsured, even after the passage of ACA, and a strong role for private insurers and employers in setting the terms of health care coverage.
France has strong price controls throughout the health care industry; whereas in the US, price controls are limited to public programs such as Medicare and Medicaid. In France, two-thirds of hospital beds are public and the private sector is dominated by for-profits (who, nonetheless, are prohibited to advertise on their activity!); in the US, two thirds of hospital beds are private and the not-for-profits dominates in most regions.
It could therefore seem almost impossible to compare the quality of the two systems. There is nonetheless a series of consistent, research-based data providing evidence that, although two to four times less expensive than their American counterparts, French hospital compare favourably with them.
A Comparative Analysis of Hospital Readmissions in France and the US
A study published in September 2015 by a mixed US and French research team on hospital readmission rates within a population of older people in France and the US provides a direct comparison: the rate for surgical conditions was 9.1 % in France compared with 15.6 % in the US.
These results, the authors said, are consistent with a previous study they conducted.
A time series study encompassing all hospitalizations in France, between 2002 and 2012 (more than 44 million hospitalizations) confirms the rate found in the previous study.
A VERY IMPORTANT INFORMATION
On average, the readmission rate in Orthopedic surgery, the field Care2care mostly focuses on, is a little less than 4%. By carefully selecting the best operators, we consider the objective of zero readmission realistic and attainable.
A table extracted from the commonwealth fund international policy survey, confirms the overall conclusion that the French health care system is more reliable than the US one.
Another metric is often used to measure health outcomes quality : patient satisfaction. Here we experiment also the diversity of French and US health care systems ; in the US you cannot find a comprehensive approach like what exists in France. A recent study by the Journal of the American Medical Association (JAMA, the largest and most regarded health professional organization in the world) “Time for Transparent Standards in Quality Reporting by Health Care Organizations”, raised concern about the fact that there are no standards governing the information healthcare organizations are delivering on their site”
On the contrary, due to his centralized single-payer run system, France has measures controlled by an independent body, the HAS. It is a permanent and systematic survey on patient satisfaction, via an electronic questionnaire that each patient is invited to complete at home, 15 days after their discharge from the care facility. The system was put in place two years ago and the first results have been published in December 2017 :
122.000 patients have completed the survey in 2017:
- 92 % are satisfied with the service delivered by physicians and surgeons ;
- 89 % with the respect of their intimacy,
- and 94 % with the respect of confidentiality and professional secrecy.