Archiv für die Kategorie „French Health Service“

French Health Service

Freitag, 27. Mai 2011

In the previous article (refer to Categories/Chairmans Blog/NHS Reform Problem in the right-hand index column) the point was made that, using the example of the French health service, which has been highly rated by the World Health Organisation (WHO), the introduction of private sector competition in the British National Health System (NHS) is not necessarily a change for the worse. The Prime Minister has also made the case that modernization is essential to save the NHS from rising costs leading to a funding gap of some £20 billion by 2015. In addition, serious concerns have now been raised by the Care Quality Commission (CQC) about the way some NHS hospitals treat elderly people. The CQC has said that three hospitals had broken the law by failing to meet essential standards of care on dignity and nutrition. We will see how the increasing number of elderly people requiring care is already of concern to the French state when we address the French health service further below.
However, the British Medical Association (BMA) representing the medical profession has already called for scrapping of the government proposed Health Bill, saying that required changes can be achieved without legislation. The Deputy Prime Minister & Liberal Democrat party leader Nick Clegg, has added a call for collaboration rather than dog-eat-dog, open competition, in the provision of health services.
Taking the standard of excellence given to the French health service by the WHO, it is instructive to look at the health and other dependency problems also facing the government in France (Les Echos Mercredi 18 Mai, 2011). The number of elderly people dependent upon state care is expected to double by 2060 (+35% by 2030). This is anticipated to result from an increase in life expectancy amongst the elderly which will be accompanied by similarly increasing problems of incapacity whether e.g. with respect to their health and/or ability to look after themselves. From 2025 the problem will worsen when the population bulge from the baby-boomer generation born at the end of WWII will begin to reach 80 years of age and require increasing care.
The French health service itself is considered by the French Health Insurance association to have worsened over the last 30 years and requires rapid structural reform. A protocol agreed on 15 October, 2009 allowed for the opening up of an optional, intermediate level of fees between the sector 1 state level and the higher sector 2 level of private practice. This applied to specialists such as surgeons, anesthetists, gynecologists & obstetricians who would in turn commit to a minimum 30% of their work being charged at the rate reimbursed to their patients by the French state social security. For their remaining work, their fees should not exceed the state social security rate by more than 50%. The association of complementary health insurance would then have encouraged its members such as not-for-profit mutuelles, health insurance companies and institutions to cover these excess charges over and above the state level, the objective being to gain the support of the great majority of practitioners to remain within this optional intermediate level of fees.
However, the net result by 2010 is that the excess fees charged and not reimbursed by the social security already represent ?2.5 billion (17% of total specialist fees) and the average excess charged has reached 54%, compared with 52% in 2009 and ???25% in 1990. The Health Insurance association, therefore, considers the current market for health services a sham in which the main aim of resetting the tariff structure seems to be only to produce fees increasingly in excess of the social security level. Further, the data for 2010 shows that within certain areas of expertise the great majority of new practitioners have opted for the private sector 2 :
? 87% of new surgeons
? 82% of gynecologists
? 66% of anesthetists
On average 58% of the medical profession (excluding general practitioners) have chosen sector 2 in 2010. For surgeons, their excess fees already represent 32% of their total remuneration. Over the last 10 years the most rapid progression within sector 2 has been observed amongst anesthetists and radiographers even though for the latter this only represents 14% of their total practitioners. There is also a regional effect with the average excess fees of private surgeons already reaching 150% above the state level in Paris & its surrounding areas, 110% in the Rhone region and 90% in Alsace.
The question for the Coalition government in the UK is whether it can rely on the BMA to do any better amongst its members to secure change on a voluntary basis i.e. through collaboration and not legislation?