David Edelberg, MD

With the World Health Organization ranking the United States healthcare system 37th in quality-a notch below Costa Rica but thankfully edging out Slovenia-perhaps it crossed your mind, as it did mine, to find out how healthcare is delivered in the top-ranked country, France. 

The French believe that every citizen has an unquestionable right to affordable healthcare. A system such as ours-one that gives preference to the rich, the powerful, and the employed while leaving more than 50 million citizens with no healthcare-is simply abhorrent to them. 

By law, every citizen must buy health insurance. There is no provision for opting out. Numerous nonprofit health insurance companies exist and are regulated by the government to function solely as conduits for premiums collected and benefits paid to healthcare providers and enrollees. 

French health insurance companies have no investors and no stocks traded on the market. You would no more invest in a French health insurance company than you would in the Red Cross. No chief executive officers (CEOs) are collecting multimillion dollar salaries. These health insurance companies don't have vast rooms with hundreds of employees who spend their days withholding payments to providers or denying benefits to enrollees for so-called pre-existing conditions. 

In France, the incessant and mind-numbing bickering between insurer, enrollee, and provider is nonexistent, resulting in a steep reduction in size of administrative staff. And the financial savings are impressive: in the United States, health insurance companies keep 20% of premium dollars for administrative costs. In France, it's 5%. 

The French have different health insurance companies for different needs. Most people are employed and, as do many employed Americans, purchase insurance through their employers. Rates are quite low, mainly because healthcare costs are low. A person earning $40,000 a year pays roughly $22 a month for his or her insurance, and the employer contributes $200 a month for that worker's insurance. 

Self-employed individuals purchase their insurance through a separate company, with the rate determined by income. Unemployed people have their entire premiums paid by the government. If you lose your job, you simply switch to the government plan until you find another job. So in France: 

Articles

One doctor looks at France's top ranked healthcare system and finds several lessons that the U.S. system could use.

Author | David Edelberg, MD

Articles

Viewpoint: What the French can teach us