French health system gets surgery

France offers its citizens the best healthcare in the world, and it isn't only the French who will tell you so. The World Health Organization ranks France at the top of its list.

The trouble is, the country cannot afford it. The French public health insurance scheme is heading for a $15.5 billion deficit this year, threatening to bankrupt the system.

"Our health system has gone mad," Health Minister Philippe Douste-Blazy told a parliamentary commission earlier this month. "Profound reforms are urgent."

But as trade unions rally in defense of free healthcare for all, the topic has become the hottest issue on the government's controversial reformist agenda, threatening further unpopularity as European parliamentary elections approach.

France is not alone in finding it increasingly hard to fund cradle-to-grave welfare systems. Across Europe, aging populations and ever more expensive medical treatments are busting budgets. The German government recently scandalized voters by introducing small charges for doctor visits and medicines.

Europeans' attachment to their public healthcare systems is strong, however, and nobody wants to see privatization. Even the conservative French government, keen to reduce the state's role in citizens' lives, has pledged to ensure "equal access to healthcare ... the central pillar of our republican pact" based on a "public and universal health insurance system," in Mr. Douste-Blazy's words.

The minister unveiled his plans Monday, estimating that the nation could save $18 billion a year: Reforms included computerizing patient records, encouraging patients to visit their family doctors before going to expensive specialists, boosting the use of cheaper generic drugs, and making patients pay a nominal $1.19 charge for each visit to a doctor.

That charge "is more a sign of taking responsibility than a real financial issue," Douste-Blazy said, aimed at making people realize that healthcare does cost money, even if citizens don't pay for it directly. "It is essential that going to the doctor should cost something, to make people realize what they are getting," says Bruno Fron, a general practitioner in Paris.

The French system - with its efficient hospitals, plentiful doctors, short waiting lists, and universal benefits - works on a system of compulsory insurance. Everyone who works pays a share of salary to the social security fund (more than matched by his employer), which pays 75 percent of the cost of all normal medical procedures. Since most people top up their insurance with profession-based funds, 100 percent of their medical costs, including medicines, are reimbursed automatically.

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