tres bon?
If Sir Keir and his earnest Health Secretary, Wes Streeting, are to be believed, change for the better within the NHS is on the way and ambitious reforms should make the service as convenient as booking your holiday or finding love online. However, could the answer be simply found by looking over La Manche and copying a healthcare system, voted the best in the world by the WHO and hailed as a model of efficiency, that of the French?
The health systems of most western developed countries are essentially alike in that they are based on the principle of universality, giving access to healthcare to as many people as possible. The major differences are how they funded, how the systems are organised and who subsequently provides the care – essentially, is it publicly or privately provided? Our NHS, taxpayer funded and free at the point of use is something of an exception. So too, at the other extreme, is the American system with its eye-watering personal costs. Most European countries, with their insurance-based models, lie somewhere between the two.
En France you will be presented with a bill at the end of each consultation or procedure but, not being the US, the charge is relatively low and averages 30 euros. Notwithstanding this charge, the patient is actually only liable for two euros as, on the proffering of their Carte Vitale, a smartcard to all who pay into the French social security system, the majority will normally be reimbursed by the state. Individuals also have top-up insurance either from a mutuelle – a non-profit organisation owned by its policyholders whose annual charge is now in the region of 80 euros – or from the medial insurer of their employer, to which they contribute half the cost.
For those, such as the long-term unemployed, who may not have mutuelle cover, various state-funded schemes make-up any shortfall. Furthermore, those who unfortunately suffer from any of thirty serious illnesses, including cancer, diabetes and Parkinson’s, can apply via their doctor to have the their local authority pick-up the entire tab. More than likely, that GP appointment will have been quickly and easily secured via Doctolib, an ingenious privately run platform launched in 2013 which allows immediate access to all test, result and procedural documentation.
This success obviously comes at a price, though. according to the Health Foundation, publicly funded health spending in France in 2022 was #4,550 per head, 26% more than Britain’s. It is the same story with many of our neighbours ranging from Ireland, which pays only 4% more to Germany, where it’s a whopping 55% more. However, it’s evidenced by more than twice the number of both general and intensive-care beds available and significantly shorter waiting-lists across the board.
In reality, the latest NHS reforms being promised appear to be far from revolutionary. By leaving the fundamentals of the system unchanged, will the proposed tinkering changes succeed where others before have failed? The reforms we should be contemplating, with the necessary consultation, legislation, change and implementation, would take years, certainly a decade, maybe two. Consequently, it would have to have totally-committed cross-party support to ensure we stay the course and do not wind-back and throw the towel-in halfway through. Like so many things it is also about spanking-the-cash: as a society we should ultimately ask ourselves whether we are prepared to spend more on health? It may only be a couple of points of GDP difference between Britain and France but, to bridge the apparent gap, will still require several tens of billions of pounds. You pays your money, you takes your choice.
