The analysis of health care systems usually holds to understand the ways different countries organize health care to their citizens. A comparative analysis ensures an opportunity to observe the points that are not in a progress and may cause some challenges for positive health outcomes. Actually, the general health care system design in a combination with some characteristics (organizational process, financing, coverage) plays an essential role in improving health care outcomes. Current paper is aimed to compare and contrast the health care systems of two countries: the USA and France.
In 2000, World Health Organization (WHO) ranked the health systems of 191 countries. It was the first analysis in the world that was based on five indicators such as: health, health equality, fair financial contribution, responsiveness, and responsiveness equality. According to its results, France has taken the first place in that rating while the USA ranked the 37th one (“World Health Report”, 2015). It means the health care system in France is the most comfortable and affordable for its population. Moreover, this country ensures the best overall health care assistance amid such well-developed countries as Italy, Austria, Spain, Japan, and Oman. Thus, the highest rating is the main reason of selecting France for a comparative analysis with the USA.
Health Statistics and Costs: Comparison between the U.S. and France
Life expectancy is the most definitive indicator of health disparities and is a measure of health outcomes that means the access to health care, health behaviors, socioeconomic status, and the environment. Healthy life expectancy is “a measure that indicates the number of years that a newborn can expect to live a healthy and productive life” (Russell, 2011). Comparing the health rate of the U.S. with other countries it is clear that the picture is disappointing, because France as well as 30 other countries exceed the USA in life expectancy. As a result, life expectancy in the U.S. of a 65 year old woman is 22.3 years lower than in France. For men at that age it is less pronounced: 18 years only (Russell, 2011).
Differences in life expectancy depend on the effectiveness of treating illnesses such as: bacterial infections, diabetes, heart disease, stroke, treatable cancers, and some complications from surgical procedures. In 2002, the U.S. amenable mortality rate before the age of 75 was 109.7 deaths per 100,000 populations (Russell, 2011). It exceeds the rate in France for 50%, despite the fact that France spends less money on health care than the USA. Unfortunately, the USA has the highest rates of obesity and all types of cancers (Holtz, 2008). State governments work on improving health care services to enhance patient health care delivery. In France the situation with diseases is not as serious as in the USA, but respiratory, skin, and osteoarticular diseases are also very common there.
The USA (1.7 trillion of dollars annually that is equal to $5267 per person) spends more than France ($4118 per person) and other developed countries on health care. Thus, it is clear that this country is a leader in health care spending (a percentage of gross domestic products (GPD) was 15.3 in 2003 while in France it was 10.1) (Holtz, 2008).
Health Care Financing: Comparison between the U.S. and France
Considering the health care financing in both countries it is necessary to note that the U.S. system relies more on private insurers. In France it is mainly publicly financed (except for the treatment that is not free: patients usually pay an up-front cost which the government partly compensates). Nevertheless, health insurance in France and the USA is closely linked to the employers/employees. This major similarity joins other basic principles (patients’ choice and freedom of medical practice).
American and French workers and their employers pay “for the bulk of their medical care through premiums assessed on gross wages” (Dutton, n.d. p.2). Therefore, French employers and employees pay wage taxes of approximately 20%, while in the U.S. it is higher on 27% (Dutton, n.d.).
Comparing health care financing of both countries it should be mentioned that American private insurers account 35% of total expenditures (in France it is 12%) and Americans pay 17% of their own money (while the French pay only 13%) for their personal spending on health care (Dutton, n.d.). Moreover, the state and federal governments in the USA play an essential role in health care system, mainly through Medicaid and Medicare (43%) (Dutton, n.d.). But even this large part cannot compare with quasi-public insurance funds in France that account mostly three-quarters of whole health care spending.
Health Care Administration: Comparison between the U.S. and France
To start with, special government administration (in most countries it is a Ministry of Health of a Department of Health) coordinates the work of health care system by overseeing and regulating the provision of health care for the citizens within the country. In France two agencies are responsible for this sector. They are:
- Ministry of Social Affairs and Health. This administration is in charge of adjusting the public health care facilities and administrating the sector of health insurance of the French Social Security system. Moreover, it establishes prices regarding to health care services and goods. Everyone can find the information, campaigns, press documents, and statistics on the site of Ministry of Social Affairs and Health.
- National Security Agency of Medicines and Health Products (ANSM). The agency is responsible for supervision and regulation of health care industry in France. The site includes the information on news, services, activities, and publications due to the requirements of ANSM. Both sites are available only in French.
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The agencies that coordinate the health care system in the USA are the following:
- Agency for Healthcare Research and Quality (AHRQ). It maintains researches to make the quality and safety of health care better with the aim to help citizens make health care decisions more informed. This agency ensures access to the information for Americans and health care providers as well as necessary research tools and data for people involved in the health care industry.
- Centers for Disease Control and Prevention (CDC). Their goals are: facilitate human health, prevent illnesses, injury and disability, and be ready for the new health threats in the USA. The information about different diseases and their conditions, healthy living, and health of travelers are available on the site of those centers. Moreover, it ensures data about new studies with their results, emergency preparedness, and varied outbreaks.
- Department of Health and Human Services (HHS). It allows collecting data of national health, offers grants, conducts researches in regard to examine food and drug safety. The website of this department provides users with the news about the health care industry and ensures information regarding prevention, regulations, and the ways that help to prepare for a potential emergency in public health.
- Guam Department of Public Health and Social Services (DPHSS).This department is responsible for control legislation on public health and welfare, environmental health in Guam (a territory of the USA). The information regarding the department, announcements and press releases are available on its site (“Healthcare: regulatory agencies”, n.d.).
Health care Personnel and Facilities: Comparison between the U.S. and France
Health care systems in the USA and France are presented by a number of facilities (public and private, for-profit and non-profit hospitals) as well as health care personnel. According to the report of World Health Organization (2015), the total number of hospitals in France is 2671 and 5556 in the USA (“Clean Care is Safer Care”).
Considering a health care personnel in both countries, France has got a high level of resources: about 3.4 physicians per 1000 people (except them, there are also family doctors and GPs). The USA provides about 2.5 physicians and 9.4 nurses per 1000 citizens (Holtz, 2008).
Access and Inequality Issues: Comparison between the U.S. and France
Access is the most noticeable difference between health care systems in researched countries. In general, 16% of the population in the USA lacks health insurance coverage and many citizens have insurance with high deductibles. Therefore, those people refuse to have it for financial reasons (Dutton, n.d.). A big quantity of uninsured population put additional load on American health care system. In such case, the providers raise the price for insured people in order to make equal the costs of uncompensated care. Hence, higher insurance premiums lead to bigger number of uninsured people.
Almost all French population (99%) obtained health insurance coverage by 1980, through work-related insurance funds or special insurance funds for the unemployed. A law accepted in 2000, extended coverage to the remaining 1% of uninsured people (Dutton, n.d.).
There are substantial disparities regarding to the access to health care in separate areas of the USA. Some of the disparities depend on culture and health practices, environmental exposure, socioeconomic status, stress, or discrimination. As a result, the U.S. ensures less access to health care to larger quantity of people than any other developed country.
In conclusion, health care systems in France and the USA have some essential differences as well as share some common principles that should be exchanged in policy approaches. American policy makers should take into consideration the success in France, especially in the field of reducing of administrative costs of insurance and French achievement of universal coverage.