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Health Systems in the USA and France


During the last decades, the state of affairs of the US health care system has been the subject to numerous brisk debates among experts, politicians, and ordinary citizens. To guarantee success of the current reforms, the USA should consider the experience of other countries in the field of health care provision. Being ranked high on the WHO overall healthcare system ranking, the French model of health care system is the excellent one to be compared with.The goal of the paper is to identify major features of health care systems in the above-mentioned countries, analyzing them according to the major criteria such as health statistics and costs, financing, administration, and access and inequality issues.

Health Statistics and Costs

While evaluating the quality of services in the health care field, researchers consider three major criteria: life expectancy, mortality rates, and the level of major health and survival from illness and diseases. According to the statistics, the US population constituted approximately 309,640,000 people in 2010 (“Health Profile: United States”, 2015). In France, the population constituted 62,634,000 people (“Health Profile: France”, 2015). In the USA, the average life expectancy is approximately 78.6 years. In France, life expectancy is 81.8 years (“Your Age”, 2015). Therefore, an average Frenchman can live three years longer than a typical American lives. During the past four decades, the US population life expectance has grown “at birth of 7.6 years” (Holtz, 2008, p. 1). The USA does not demonstrate excellent results. According to the Commonwealth Fund Report, the USA took the last places among the 19 developed countries on the avoidable mortality and the survival rate (Reid, 2010). Moreover, being a world-recognized leader in the economic field, the USA ranks below the major part of European and even some East Asian countries in terms of life expectancy. For example, infant mortality rates per 1,000 births make 3.41% in France (Reid, 2010). The USA showed the worst results among 10 developed countries with its 6.37% level of infant mortality (Reid, 2010). In the USA, the key reasons of deaths are coronary heart disease (393,698 cases), Alzheimer’s (251,745 cases), and lung cancers (11,504 cases), which makes 18.06 %, 11.55%, and 7.87% respectively (“Health Profile: United States”, 2015). In France, among the major reasons of death, coronary heart disease takes the first place (39,932 cases), Alzheimer’s (39,069 cases), and stroke (34,411 cases), which makes 9.66%, 9.46%, and 8.33% respectively (“Health Profile: France”, 2015). Therefore, the US level of deaths caused by diseases is higher than the French one.

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Health Care Financing

Health care financing is extremely important. According to the statistics, in the USA “in 2004, total health spending as a share of GDP was 15.35%, and health expenditures per capita were $6,100” (Holtz, 2008, p. 1). These data are the most significant ones as compared to any country of the world. The levels of the US expenditures per capita are about 5% during the last decade (Holtz, 2008, p. 1). The pharmaceutical sphere got about $753 per capita in 2004 (Holtz, 2008, p. 1). In France, total health spending was about €208 billion, which makes 11% of GDP (Shevreul et al., 2010, p. 43). Therefore, France’s health care expenditures are about 4% lower than the US ones, making about €2,895 per capita (Shevreul et al., 2010, p. 43).

In the United States, the health care system is financed through the private sector predominantly. For example, the number of Americans, younger than 65 years of age and possessing private health insurance plans, exceeds 70% (Holtz, 2008, p. 1). Under the circumstances, employers are mediators, providing their employees with the healthcare coverage. Moreover, the US government suggests health insurance packages Medicare and Medicaid for the poorest categories of the US citizens. Medicare is intended to support people aged 65 and older. It suggests covering expenditures on hospitalization, nursing, consulting physicians, laboratory analysis, and medical supplies. Nevertheless, Medicare does not deal with the covering expenditures on the vast majority of prescription medicines (Holtz, 2008, p. 1). The second government program is Medicaid that “is a safety net program for people with low income, mostly women, children, and the elderly and disabled, who receive federal or state financial assistance” (Holtz, 2008, p. 2).

Approximately 50% of the US hospitals have non-government sources of financing (Holtz, 2008, p. 2). For example, 3025 out of 5794 hospitals were non-government owned (Holtz, 2008, p. 2). The payment for medical treatment in hospital takes approximately 30% of the overall healthcare costs in the USA that spends about $650 billion on this purpose (Holtz, 2008, p. 3). Medicaid takes 43.5% of these expenditures, private insurance gets 31.2%, Medicaid has 18.3%, and the uninsured part demonstrates 3.8% respectively (Holtz, 2008, p. 3).

In France, the health care system is a mixed type one. It is based on the Bismarck approach combined with Beveridge goals. It suggests the use of “the single public payer model, the current increasing importance of tax-based revenue for financing health care” (Shevreul et al., 2010, p. 43).

Healthcare Administration

The French health care system suggests strong state intervention. SHI health care package provides almost total covering of the resident population. The French citizens have access to “private, fee-for-service physicians, private profit-making hospitals, private non-profit-making hospitals, and public hospitals” (Shevreul et al., 2010, p. 43). According to the 2004 Health Insurance Reform Act, VHI companies are allowed to administrate the French health care system. In fact, approximately 1500 VHI companies are combined into the National Union of Complementary Health Insurance Organizations (UNOCAM) (Shevreul et al., 2010, p. 43).

There are three models of regulating VHI companies. They are the mutual insurance code, the commercial insurance code, and the social security code. Physicians and hospitals share the responsibility for suggesting quality health treatment. Several administrative bodies manage hospitals in France. They are “the government, non-profit-making organizations, which include charities and mutual benefit societies, and profit-making hospitals, which are increasingly concentrated in the ownership of large international groups” (Shevreul at al., 2010, p. 112).

On the contrary, the USA does not imply this system. Most Americans are covered with health insurance. In fact, health insurance coverage makes 80% among non-elderly category of American citizens. Typically, they get the insurance while employed. Moreover, the employer allocates the necessary sum from the monthly premium on the health coverage (Reid, 2010).   Thus, insurance money is distributed unevenly. While a part of Americans receives all packages of services paid by their insurance plans, many people do not get proper treatment for serious diseases (Reid, 2010).

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Access and Inequality Issues

While evaluating health care systems of different countries, researchers argue that all countries face numerous difficulties in the field of medical care. The common burning problem of every national health system is the growing costs of services. In fact, this phenomenon can be explained by positive reasons such as inventing new effective drugs and medical devices. Nevertheless, the American large expenses in the health insurance field are promoted by the increased strive for huge profit. Medical staff, clinics, and drug companies receive money that exceeds the profit of their foreign colleagues manifold. Doctors and nurses try to return expenses on their education. For example, American students had to return loans exceeding $100,000 after their graduating (Reid, 2010). Moreover, in the USA, malpractice insurance costs an enormous sum as compared to $1,000 for malpractice insurance in France. The reason for it is numerous cases of patients’ filing lawsuits on their doctors (Reid, 2010).

France provides a statutory health insurance system with compulsory coverage of all the citizens. In France, about 90% of the population chooses voluntary insurance plans. In the USA, a worker’s medical bills are paid from his or her monthly premium (Reid, 2010). Nevertheless, American insurance firms spend a part of health coverage money on marketing, underwriting, and administration. Moreover, they make great profit doing business in the health care field. Typically, an average family has to pay about $16,000 for health insurance (Reid, 2010).

Approximately 130 health insurance companies provide medical coverage for the American citizens. Twenty-five of them cover about two-thirds of the US citizens possessing health insurance plans. The most famous of them are United Health Group, Wellpoint Inc. Group, Kaiser Foundation Group, Humana Group, and Aetna Group. In France, every citizen can get health care coverage irrespective of the age and social status of a person. In France, residents can choose any doctor or medical clinic in any place of the country.

As it has been stated, Medicare supports people aged 65 and older, and it covers expenditures on hospitalization, nursing, consulting physicians, laboratory analysis, and medical supplies. At the same time, Medicaid that also covers those who cannot afford to have health insurance but still need medical care. Medicaid expenses include fees for consulting physicians, hospitalization, and home nursing. Meanwhile, the authorities determine the limits of benefits in each US states in their own way.

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The US health care system has been the subject to debate during the last years. To guarantee the success of the reforms in the field, the best global practices are to be studied and implemented. The French health care model is one of the most successful systems in the world. Major features of American and French health care systems were examined according to the health statistics and costs, financing, administration, and access and inequality issues. According to the levels of life expectancy, mortality, the rate of major health and survival from diseases, the USA results leaves much to be desired. American health care financing exceeds the French one. The US financing is made through a combination of public and private sectors, while the public sector is the key one in France. The French health care system suggests the strong state intervention. On the contrary, the USA does not imply this system. The major part of Americans possesses health insurance. Both the USA and France face numerous difficulties in the field of medical care. The common problem of every national health system is growing costs of services. Taking into account all the above-mentioned information, the conclusion is as follows. The US government pays great attention to the state of national healthcare, directing substantial funds to boost the system. Nevertheless, wise steps are expected to be made to improve the situation. The model of French healthcare system is one of the examples to follow.