In France, a compact with the family

Comprehensive free prenatal and postnatal care for all is one of the pillars of France's much-admired medical insurance model.

Jennifer Gilroy / Special to The Christian Science Monitor
A doctor examines young Jasmine, the daughter of Ishmahane Bellal (right), at a free clinic in Orleans, France. The country offers free prenatal and postnatal care for all families – one of the pillars of France’s much-admired medical insurance system.

Like most new mothers, Tiphaine Glaesener was overcome with emotion and fatigue after giving birth to her daughter four years ago. As she lay in her bed in a public maternity hospital, she cried – and cried some more.

The French healthcare system sprang into action.

The women who brought her meals told the midwives. The midwives alerted the doctors and nurses. They in turn informed the social workers. Mrs. Glaesener had already been in the hospital for four days, a standard stay for new mothers. But if she was feeling "fragile," as the hospital team put it, why not stay a few days longer?

Although she declined the offer, she and her baby, Maëlle, could easily have enjoyed constant care for another eight days. It would not have raised an eyebrow. Nor would it have cost her a single centime.

"Pregnancy is taken really seriously here," says Glaesener, who is now pregnant with her second child. "We are pampered and monitored. And my pregnancy cost me nothing because I stayed within the public system."

Comprehensive free prenatal and postnatal care for all is one of the pillars of France's much-admired medical insurance model, which consistently ranks at or near the top in global ratings.

The guiding principle of France's system is simple. People pay a percentage of their income into state-supervised medical insurance funds, through a combination of income taxes, payroll deductions, and employer contributions. Everyone has coverage, with insurance paying most or all the costs of basic doctors' visits, drugs, and hospitalization.

Taxes are high in France. But healthcare is considered a universal right. Doctors are trained at state expense and so do not start their careers burdened with medical-school debt. The poor pay nothing for the obligatory insurance. Students pay €198 ($291) a year. But protection is the same regardless of income, age, or health.

The state does not limit what doctors can charge, but sets in-network rates for various services. The in-network fee for an office visit to a general practitioner, for example, is now €22 (and €26 for a house call). The patient pays the doctor upfront, and the insurance system reimburses 70 percent of the fee, usually within about three weeks.

All but 8 percent of French households also buy supplemental insurance to cover the remaining 30 percent, with a bare-bones policy starting at about €50 a month. More expensive policies cover extras like private hospital rooms and doctors' fees that exceed the in-network rates.

The more severe the illness, the less patients pay from their own pockets. Treatments for severe or long-term illnesses are 100 percent covered by the national system, and doctors decide what treatments and procedures to prescribe.

All this comes at a hefty cost. The national medical insurance fund has run in the red for the past 38 years. This year's shortfall is projected to be €10 billion ($15 billion), an amount that has to be made up in direct annual government aid.

The government has tried some tweaking in an attempt to rein in costs, such as reimbursing less for nongeneric drugs and forcing public hospitals to share costly diagnostic equipment. But the gold standard still applies in the case of chronic diseases and maternal and child health.

From the fourth month of her pregnancies, Glaesener did not have to pay for her doctor's visits, midwife consultations, scans, tests, or vitamins. The consultations were obligatory, although she would not have faced sanctions for missing them.

After giving birth, she also had the right to free sessions with a physical therapist, highly encouraged by the insurance fund, to strengthen her pelvic muscles and get back into shape. A midwife came around as well for a home visit provided to all new mothers – whether they had cried in the hospital or not.

"They want to see the relationship between the mother and the baby," says Glaesener, a medical resident who is close to starting her own career as a doctor. "That's very important and it also reduces infant mortality."

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