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Global

technologies. In some cases, hospitals in dan-

However, French physicians have shown

ger of exceeding their budgets have pushed

growing resistance to efforts at limiting

budgets and fee

patients to other facilities to save money.71

physician reimbursement with several recent

restrictions for

strikes and protests.66 In the face of growing

Finally, the government has tried to curtail

hospitals have led

budgetary problems, future conflict may well

the use of prescription drugs. The French have

be brewing.

long had an extremely high level of drug con-

to a recurring

More significantly, the government has

sumption. French general practitioners (GPs)

lack of capital

prescribe on average €260,000 worth of drugs a

recently begun imposing restrictions on access

€

year.72 However, the National Health Authority

to physicians. A 2004 study by the High

investment,

Council on the Future of Health Insurance

has begun de-listing drugs from its reimburse-

resulting in a

ment formulary.73 Many French patients have

raised questions about "the legitimacy of the

shortage of

complete freedom enjoyed by health profes-

responded by switching to similar, reim-

sionals in setting up their private practice."67

bursable drugs, but some patients may not be

medical

getting the medicine they need. For example,

And in 2005, the government adopted a system

technology and

one study found that nearly 90 percent of

of "coordinated care pathways." Under the new

lack of access to

French asthma patients are not receiving drugs

system, which operates very much like man-

that might improve their condition.74

aged care in the United States, patients are

the most

encouraged to choose a "preferred doctor" and

Government regulation and bureaucracy

advanced care.

to follow the "pathway" suggested by that doc-

have also been blamed for rigidity in the

tor. The effect is both to lock patients into a

French system, preventing it from reacting

choice of primary care physician and to establish

quickly to changing circumstances. For exam-

a "gatekeeper" who limits access to specialists,

ple, mismanagement and the inability of the

tests, and some advanced treatment options.68

system to cope with emergencies were blamed

in part for the deaths of 15,000 elderly individ-

So far, the new system has been more of a

uals in the summer of 2003 during the

gentle push than a mandate. If the new system

European heat wave; and a shortage of hospi-

is not used, copayments may be slightly higher

tal beds occurred in 2004 when a nationwide

or reimbursements slightly lower, much like

flu and bronchitis epidemic broke out.75

going "out of network" in the United States.

But if costs continue to rise, the new system

Although the changes made so far do not

may be extended and made more rigorous.

amount to rationing, 62 percent of French

Of more immediate concern, global bud-

citizens report that they "have felt the effects"

of the new restrictions.76 Slightly less than

gets and fee restrictions for hospitals have led

to a recurring lack of capital investment, result-

half consider the waiting time between diag-

nosis and treatment to be acceptable.77

ing in a shortage of medical technology and

lack of access to the most advanced care. For

Valentin Petkantchin, a scholar with the

example, the United States has eight times as

Institut Economique Molinari, warns that

many MRI units per million people and four

France is in danger "of joining the group of

times as many CT scanners as France.69 This

countries [such as] the UK and Canada, where

the existence of rationing of health care and

partially reflects the more technology-reliant

waiting lists raises serious questions of access

way of practicing medicine in the United

to treatments by those who need them."78 And

States, but it has also meant delays in treat-

ment for some French patients. Also, strong

some French health professionals have sug-

disparities are evident in the geographic distri-

gested that waiting times for care have begun

to lengthen.79

bution of health care resources, making access

to care easier in some regions than others.70

The impact of all these cost containment

measures is alleviated to some degree by the

Thus, while the French system has generally

ability of French patients to privately contract

avoided the waiting lists associated with other

for care outside the public system. If a drug is

national health care systems, limited queues

removed from the national formulary, patients

do exist for some specialized treatments and

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