Comparison of Healthcare Policies between France and the US

IntroductionThis essay aims to critic entirey discuss well-disposed policies on wellnesscare between France and the US. Similarities and differences on the social policies of these two countries lead be discussed. The first let on of this essay aims to explore how normal funding for wellness care serve in twain(prenominal) countries address health inequalities. A critical discussion on health care function available in both countries and the design to which oecumenical access to health care services is applyd shall excessively be made. The second part presents the challenges that both countries face in addressing health care issues. healthcare policies that address these issues will also be critically appraised. The trey part provides an analysis on whether France and USA are converging or fol menialing alley habituation on their health care policies. A brief conclusion summarising key points raised in this essay will be presented in the end.Healthcare Services an d Public Spending for HealthcareThe healthcare strategy in France is described as a mix of private and creation insurers and providers (Cases, 2006). This means that around the whole secern is strain by earthly concern policy, which in turn are funded by employers and employees. In addition to public health insurance, a minority also purchases private insurance to complement existing public health insurances. Private providers support outpatient care while public providers provide inpatient care in hospital settings (Cases, 2006). France enthralls relatively good health compared to the US. The Organisation for Co-operation and Development (OECD, 2013) Health Statistics in 2013 reveals that life expectancy in France is blue at 82.2 and is currently ranked third amongst OECD countries. In rail line, life expectancy in the US is amongst the lowest at 78.7 (OECD, 2013).The difference in life expectancy in both countries is a pretend of misgiving since the US has one of th e most expensive healthcare systems in the OECD and yet fares worse in health outcomes, including life expectancy(Baldock, 2011). The OECD (2013) nones that compared to France and other large OECD countries, the US spends twice as much per individual on healthcare. Interestingly, public health disbursal for health is highest in the US compared to all OECD countries. However, it does not practice universal healthcare insurance coverage with the public supporting only 32% of the total healthcare exist (OECD, 2011). Individuals suitable for Medicaid include the elderly, families with small children and those with disabilities (Rosenbaum, 2011). Approximately 53% of the US cosmos is covered through the Patient auspices and low-priced Act or Obamacare (Rosenbaum, 2011). Under this Act, employers are required to purchase health insurances for their employees. Only a small portion of businesses pays for full coverage with majority requiring their employees to share in the cost of their health insurances (Rosenbaum, 2011).The OECD (2009a) states that 46 million people in the US are left without public or private health insurance. This could place a significant burden to the US healthcare system that is struggling in providing honest access to healthcare services in the country. The World Health Organization (2014) exempts that equitable access is strived when individuals, no matter of their socio sparing berth, please the same typeface and pure tone of healthcare. This is not achieved in the US where statistics (OECD, 2009a) continues to show that high-income multitudes enjoy erupt health and appropriately covered by healthcare insurances while those in the lower socio economic status continue to film poorer health status. This disparity in health status and healthcare insurance coverage continues to be a challenge in the US.Public expending per capita in the US continues to be the highest in the OECD countries even with the increased participatio n of the private sector in financing healthcare in the country (OECD, 2013). In impudent geezerhood, the OECD (2013) observes that public using up across OECD countries continue to decline. On average, healthcare expenditure of these countries only grew by 0.2% in the last 4 years. While there is a variation on the decrease of public spending, the major reason for the slowdown is cod to drastic cuts in health expenditures. In France, the Statutory Health Insurance (SHI) currently covers near all residents. Until 2000, SHI covered 100% of all residents (Franc and Polton, 2006).Today, almost all of the residents are yet covered under SHI. However, a few have purchased private health insurances to complement SHI. Public spending for healthcare is 77.9% while France spends 11.9% of its GDP in healthcare (OECD, 2011). This is in contrast with the US where public spending for healthcare accounts to only 47.7% entirely spends 17.9% of its GDP on healthcare (OECD, 2011). Interesti ngly, SHI covers both efficacious and illegal residents in France. This is opposite in the US where illegal residents are not covered by publicly funded healthcare insurance. There are approximately 21 million immigrants in the US with most having an illegal resident status ( sour, 2011). Health coverage remains to be a concern for this group since they work on jobs that pay very low wages and with no healthcare coverage. Hence, this group is three times much likely to have no healthcare coverage (Stanton, 2006). Currently, this group comprises 20% of the total uninsured population in the US (Moody, 2011). The lack of universal coverage in the US implys that healthcare policies in the US may not be inclusive as opposed to France where almost all residents have private or public health insurance coverage.Rosenbaum (2011) explains that the Patient protection and Affordable Act or Obamacare is pass judgment to boost healthcare coverage for legal immigrants who are in low paying jo bs. However, only legal immigrants who have been in the US for at least five years could qualify for Medicaid or purchase state-based health insurances. Currently, all states in the US have expanded Medicaid coverage to low-income groups. Specifically, a family of four with a combined annual income of $33,000.00 and an individual with $15,800.00 yearly income are now worthy for Medicaid. This legislation provides health coverage to approximately 57% of the uninsured population in the US (CDC, 2011). For legal immigrants who have not reached five years of stay in the US or are earning more than the Medicaid limit are allowed federal subsidy when purchasing state-based health insurances (CDC, 2011).As opposed to France where illegal immigrants enjoy the same healthcare coverage as legal immigrants and citizens, those in the US on illegal status remain uninsured and could not purchase state-based health insurances (CDC, 2011). Healthcare access for this group is limited to familiarit y health centres across the country. It is noteworthy that only 8,500 confederacy health centres are in existence now and yet they cater to at least 22 million people each year (CDC, 2011). to the highest degree half of those who access primary health centres are the uninsured. While hospitals are required by legal philosophy to provide emergency care for all individuals regardless of their resident status, those who are uninsured do not have health coverage to sustain their long-term healthcare needs (Rosenbaum, 2011). Current healthcare policies in the US might actually promote health ine look since it only provides primary basic healthcare services (CDC, 2011) to the marginalised group, which may include low-income and ethnic groups.In France, The Bismarckian admittance to healthcare has been used for some(prenominal) decades but in recent years, there is now an adoption of the Beveridge approach (Chevreul et al., 2010). In the former, health coverage tends to be uniform an d concentrated while in the latter, the single public payer model is promoted. In the Bismarckian approach, everyone should be given the same access to healthcare services while the Beveridge model allows for stronger state intervention (Chevreul et al., 2010). This also suggests that tax-based revenues are used to finance healthcare. The mix of both models is necessary to suffice to the increase demands for healthcare in the country and to regulate the increase cost of healthcare. Chevreul et al. (2010) emphasise that the SHI is now experiencing deficit due to increase rise of healthcare expenditure in the country.The cut parliament, through the Ministry of Health regulates expenditure by enacting laws and regulations. Importantly, France regulates prices of specific medical procedures and drugs (Chevreul and Durand-Zaleski, 2009). This development is crucial since failure to regulate prices could further drive up healthcare be. However, regulation of prices of medical devices r emains to be poor. In a survey (OECD, 2009b), expenditures for medical devices is high and amounts to 19 billion annually. Although it comprises 55% of the pharmaceutical market, increased demand for medical devices have also increased SHI expenditures on these devices (Cases and Le Fur, 2008). It should be note that only 60% of the medical devices are covered by SHI (Cases and Le Fur, 2008). Regulation of the prices of these medical devices is not as strong as the market for drugs and other major medical equipment. This implies that change magnitude healthcare be of medical devices could have an impact on public health spending policies in France.Healthcare Issues and ChallengesOne of the major issues in both countries is the rising healthcare expenditure. As noted by the OECD (2013), there is a disparity between healthcare expenditure and rising healthcare be in OECD countries. The average increase in healthcare expenditure only amounts to 0.2% and yet healthcare cost continue s to rise. In France, this disparity has promoted the Ministry of Health to increase private insurance of its members to help cover healthcare services not normally covered by the SHI. In the US, the debate on Obamacare and the reluctance of the government to cover illegal residents continue to be a challenge in providing equitable healthcareMeanwhile, high cost of medicines could have an impact on healthcare, especially amongst those who are covered by Medicaid and those who could barely expend state-subsidised healthcare insurances (Moody, 2011). This is in contrast to France where cost containment is in place for medicines. To illustrate the lack of healthcare costs regulations, the US spends more on developing medical technologies, which only benefits a few of the patients. The country is also burthen with high administration and pharmaceutical costs. Doctors in the country are also amongst the highest paid in the OECD countries (Greve, 2013). Moody (2011) argues that cost con tainment remains to be a problem since lowering down prices of medicines or healthcare costs for beneficiaries of Medicaid would lead to doctors reluctance to treat Medicaid patients.The lack of priorities in healthcare spending in the US has resulted in higher spending on certain areas and low spending on others. However, this does not translate to better health outcomes for the whole population. Elderly care is one area where there is high spending but the amount of spending does not necessarily translate to better health outcomes. As noted by Haplin et al. (2010), the elderly are more vulnerable to chronic healthcare conditions, such as dementia, cardiovascular diseases, type 2 diabetes. Hence, healthcare costs for this group are relatively higher compared to other members in a community. In a report published by Stanton (2006), approximately 40% of US healthcare expenditure is devoted to elderly care, but this group only comprises 13% of countrys population. It is projected that in the succeeding years, healthcare cost for this group will continue to rise with the ageing of the US population (Stanton, 2006).The same issue is also seen in France, where increasing healthcare cost for the elderly is also expected in the succeeding years (Franc and Polton, 2006). Both countries also lack coordination of care and gatekeeping for the elderly. Although there is an emphasis on elderly care in both countries, lack of continuity of care often leads to poor quality care, duplication of healthcare, waste and over-prescription (Franc and Polton, 2006 Evans and Docteur and Oxley, 2003 Stoddard, 2003). In France, this issue was first addressed through the creation of provider networks and increasing the gate-keeping roles of the general practitioners (GPs). However, the latter was largely unsuccessfully and finally abolished with the introduction of the 2004 Health Insurance Act (Franc and Polton, 2006). In this brand-new legislation, patients have the freedom to choose their own healthcare providers or primary point of contact. most(prenominal) of the primary points of contact are GPs. This scheme is successful in France due to incentives offered to the patients and GPs. This scheme has been suggested to improve the quality of care received by the patients since there is more coordination of care between GPs and specialists (Naiditch and Dourgnon, 2009). This scheme also drives up the cost of visits to specialists and could have influence healthcare financing policies (De Looper and La Fortune, 2009 Naiditch and Dourgnon, 2009).Another issue viridity to both countries is the competition between hospitals for patients who can afford private healthcare. Consumer demands for healthcare in the US have increased. Hospitals respond by increasing their services to separate them from their competitors (Moody, 2011). For instance, by-products of this competition results to increasing the size of the patient room and providing in-house services such as full kitchens, family lounges and business service. All these have not been related to meliorate health outcomes of the patients. In France, the differences in healthcare costs between publicly funded hospitals and private for-profit hospitals spark a debate on whether common tariffs are the solution to cost containment (Chevreul et al., 2010). Despite the implementation of common tariffs, there is still a growing difference on the healthcare costs between the private and public sectors. Currently, the reform plan Hospital 2007 (Chevreul et al., 2010) states that the objective of introducing a common tariff for public and private hospitals has been withheld until 2018. This shows that healthcare policies respond to current trends in health provision in France.Convergence and Path DependenceStarke et al. (2008) explain that history and institutional context all play a role in influencing healthcare policies in a welfare state. Healthcare policies that tend to be resistant to change illustrate institutionalist or path dependence.In the event where changes are needed, those that follow path dependence change their policies but do so within the boundaries set in the original healthcare policies. On the other hand, healthcare policies that follow the carrefour pathway or functionalist perspective tend to integrate best practices and are more responsive to social, policy-making and economic changes.Healthcare policies in France and the US tend to follow the convergence pathway. The historical context of France reveals that a unitary presidential democracy was established in 1958 (Cases, 2006). In this system, the central government retains sovereignty and policies apply in local or regional levels are approved by the central government. Despite the practice of central dirigisme, many an(prenominal) regions in France have practiced coordination and decenstralisation. Political parties elected to the French government all have a common goal in financing the healt hcare system in France. It practices cost-containment by regulating healthcare costs, reducing healthcare demands and restricting healthcare coverage (Chevreul and Durand-Zaleski, 2009). All these cost-containment policies have largely been met with public discontent. In recent years, the introduction of Supplementary Health Insurance enabled the French government to still deliver quality care at reasonable cost. Further, the introduction of direct payment, although reimbursable, also discourages wasteful role of healthcare (Chevreul and Durand-Zaleski, 2009).Although changes in healthcare policies tend to be restrictive more than three decades ago, France is now pickings the convergence pathway in its healthcare system. This suggests that healthcare policies are more responsive to social and economic changes. France also regards its people as equal but retain their freedom to choose a healthcare provider and hospital. The manner of healthcare financing in France allows service us ers to choose from competing healthcare professionals. Service users could also access specialists due to little gatekeeping in the country (Naiditch and Dourgnon, 2009). All these changes in the Frances healthcare system reflect convergence rather than path dependence.Convergence in healthcare is also shown in both countries through its policies on increasing personal contributions of service users for healthcare (Mossialos and Thomson, 2004). There is also an increasing reliance on private health insurers to bridge the transgress in public healthcare delivery. The increasing public-private mix exemplifies convergence. There is also a trend towards community healthcare and decentralisation of healthcare (Baldock, 2011 Chevreul et al., 2010 fair and Burau, 2007). This trend relies on community healthcare practitioners to provide care in home or community settings. This has been practiced in other developed countries where patients with chronic conditions receive care in their own homes (Chevreau et al., 2010). This approach is also applied when caring for the elderly. Similar to other Welfare states, the US and France are experiencing population ageing. The proportion of the elderly in both countries is expected to rise in the succeeding years (Chevreau et al., 2010). As mentioned earlier, this translates to increases in health expenditures and cost for this group. Marked increases in health expenditures for this group would mean further reduction on public spending or cost containment. All these could have an impact on public spending in the future and might increase insurance premiums of individuals.There is also the possibility of raising SHI contributions in France or reducing healthcare coverage of Medicaid in the US. Both strategies could fuel public discontent, increase the gap between the rich and the poor and promote health inequalities (OECD, 2008 Starke et al., 2008 Stanton, 2006). Since the main aim of the policies in both countries is to achiev e optimal health for all, the realisation of this aim might be compromised with an ageing society. It is also noteworthy that since public funds are bankrolled by taxes, increasing spot of elderly could mean reduction in number of employees who are economically productive. This could also lead to lower tax collections and decreased public funding for healthcare. As shown in both countries, healthcare policies are becoming more responsive to the social and economic changes. This does not only suggest a direction towards convergence but suggests that this pathway could be the norm for many OECD countries.ConclusionHealthcare policies in the US and France have been influenced by social and economic changes in recent years. Although both aim to achieve universal coverage, it is only France that has achieved this with almost 100% of its citizens covered with healthcare insurance. The US is struggling to meet the healthcare needs of its citizens with almost 46 million still uninsured. It s Obamacare is still met with reproach for its failure to provide public healthcare coverage for most of its citizens. Only the poor and those unable to afford basic healthcare services are covered under Medicaid. In Obamacare, those with marginal incomes could purchase federal-subsidised healthcare insurances. Both countries are also faced with the challenge of an ageing society. The inequitable allocation of healthcare services to this group also promotes social discontent. Almost half of public expenditure is channeled to the elderly, which only comprises 13% of the whole population. The heightened demand for elderly care, lowered public expenditure on healthcare and increasing healthcare costs have all influenced healthcare policies in the US and France. Finally, the recent changes in the healthcare policies of this country suggest convergence rather than path dependence suggesting that healthcare policies continue to be influenced by social and economic changes in both countri es. It is recommended that future research should be done on how convergence helps both countries respond to increasing complexities of healthcare in both countries.ReferencesBaldock, J. (2011). Social policy, social welfare and the welfare state. Oxford Oxford University Press.Blank, R. & Burau, V. (2007). Comparative health policy. capital of the United Kingdom Palgrave.Cases, C. (2006). French health system reform recent implementation and future challenge. Eurohealth, 12, pp. 10-11.Cases, C. & Le Fur, P. (2008). The pharmaceutical file, Health Policy Monitort, May Online. unattached from http//www.hpm.org/survey/fr/all/2 (Accessed twenty-seventh April, 2014).Center for Disease Control and Prevention (2011). NCHS Data Brief Community Health Centers Providers, Patients and meaning of Care Online. Available from http//www.cdc.gov/nchs/data/databriefs/db65.htm (Accessed 27th April, 2014).Chevreul, K., Durand-Zaleski, I., Bahrami, S., Hernandez-Quevedo & Mladovsky, P. (2010). Franc e Health System Review 2010. France The europiuman Observatory on Health Systems and Policies, WHO Regional Office for Europe, World Bank, European Commission, UNCAM, London School of Economics and Politic Science, and the London School of Hygiene & Tropical Medicine.Chevreul, K. & Durand-Zaleski, I. (2009). The role of HTA in coverage and pricing in France toward a new paradigm?. Euro Observer, 11, pp. 5-6.De Looper, M. & La Fortune, G. (2009). Measuring disparities in health status and in access and use of healthcare in OECD countries. Paris OECD (Health working newspaper publisher 43) Online. Available from http//www.oecd-ilibrary.org/social-issuesmigration-health/measuring-disparities-in-health-status-and-in-access-and-use-of-healthcare-in-oecd-countries_225748084267 (Accessed 27th April, 2014).Docteur, E. & Oxley, H. (2003). Health-care systems lessons from the reform experience. Paris OECD (Health working paper 9) Online. Available from http//www.irdes.fr/Publications/Qes/Qe z133.pdf (Accessed 27th April, 2014).Evans, R. & Stoddard, G. (2003). Consuming research, producing policy?, American Journal of Public Health, 93, pp. 371-379.Franc, C. & Polton, D. (2006). New governance arrangements for French health insurance. Eurohealth, 12, pp. 27-29.Glyn, A. (2006). Capitalism unleashed. Oxford Oxford University Press.Greve, B. (2013). Routledge Handbook of the Welfare State. London Routledge.Halpin, H., Morales-Suarez-Varela, M. & Martin-Moreno, J. (2010). Chronic disease prevention and the new public health. Public Health Review, 32, pp. 120-154.Moody, K. (2011). Capitalist care Will the coalition governments reforms move the NHS further toward a US-style healthcare market?. Capital and Class, 35(3), pp. 415-434.Mossialos, E. & Thomson, S. (2004). Voluntary health insurance in the European Union. Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies Online. Available from http//www.euro.who.int/__dat a/assets/pdf_file/0006/98448/E84885.pdf (Accessed 27th April, 2014).Naiditch, M. & Dourgnon, P. (2009). The preferred doctor scheme a political reading of a French try out of gate-keeping. Paris IRDES.OECD (2013). Health at a glance 2013 OECD Indicators, Europe OECD Publishing Online. Available at http//dx.doi.org/10.1787/health_glance-2013-3n (Accessed 27th April, 2014).OECD (2011). Human Development Index and its components. Europe OECD.OECD (2009a). Society at a Glance 2009 OECD Social Indicators. Europe OECD.OECD (2009b). Health data 2009. Paris OECD.OECD (2008). Are we growing unequalOnline. Available at www.oecd.org (Accessed 17th April, 2014).Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act Implications for Public Health Policy and Practice. Public Health Reports, 128(1), pp. 130-135.Stanton, M. (2006). The high concentration of U.S. healthcare expenditures research in action, issues 19. Rockville, MD Agency for Healthcare Research and Quality.Starke, P., Obginer, H. & Castles, F. (2008). Convergence towards where in what ways, if any, are welfare states becoming more similar?. Journal of European Public Policy, 15(7), pp. 975-1000.World Health Organization (WHO) (2014). Health Systems Equity Online. Available at http//www.who.int/healthsystems/topics/equity/en/ (Accessed 27th April, 2014).