9 January 2007 – Since 1945-46, the French system of Social Security has been imposing a mandatory health insurance and thus has a captive clientele – as the insured are compelled to finance it. This system has been, and is still, justified in a great measure in the opinion of the general public on grounds that it allegedly leads the French people to become equal in health and provides financing of all the cares they might need.
“Yet, more than sixty years after, we have to acknowledge that both justifications turn out to be myths”, declares Valentin Petkantchin, author of a new study on the subject.
On the one hand, it is illusory to believe that the imposition of a single public insurance plan can make the insured equal in health. Disparities in the mortality rate endure in France, both from a geographical point of view and among different socio-professional categories. Significant inequalities as to the access to physicians, specialists, hospital beds and medical equipment still exist.
On the other hand, as the author reminds it, “the fact is that in the area of healthcare as in every other area of economic activity, resources remain scarce and limited.”
Faced with the inherently limited character of medical resources, successive governments in France have engaged in cost containment measures, leading to overall planning and bureaucratization of the healthcare system.
France risks of joining the group of countries as the UK and Canada where the existence of rationing of healthcare and waiting lists raises serious problems of access to treatments by those who need them. In this respect, the case of Canada is illuminating: public spending per capita has almost doubled (after inflation taken into account) in 30 years in this country. But waiting time has actually soared going up from 9.3 to 17.8 weeks in average between 1993 and 2006.
Opening health insurance to competition
If we do not wish to suffer from the drawbacks of public policies of rationing in the future, it is time to consider a genuine opening of the area of health insurance to competition.
“In such a system, it will indeed always be possible to finance the health coverage of the poorest persons through “health insurance” voucher checks, if need arises”, says Mr. Petkantchin.
Public assistance, if it is judged necessary in some cases – without engaging in vain attempts at overall controlling and planning of the health system in the hunt for a hypothetical balanced budget – could be provided by financing directly the health coverage of healthcare beneficiaries.
Entitled, Pernicious myths about public health insurance in France, the Economic Note is available at : https://www.institutmolinari.org/spip.php?article489
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