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Regulation works: a postcard from France

All eyes may be on the US just now when it comes to discussions about health care reform, but perhaps it’s worth looking to the French as well.

Croakey’s roving health correspondent Simon Burrow reports on his recent experiences with the French health system:


“Having collected a dose of tick-bite fever (Rickettsia) on a recent trip to South Africa, I went to a doctor in Cape Town and was given antibiotics.

Unfortunately, this did not do the trick and on returning to France via the USA, the chronic arthritis-like symptoms, headaches, irritating cough and fever had increased, not abated.

No other choice – a first foray into the world of French healthcare.

What a revelation! A wonderful example for regulation, versus the more accepted philosophy of de-regulation. (Can’t believe I’ve just written that).

Living in rural France, you are ‘expected’ to patronise the doctor closest to your home. However, it is not compulsory. I turned to the little village of Bonnieux where friends had said that Dr Paul le Bars spoke ‘good English, but you have to make the appointment in French first!’.

No problem, a telephone call and a charming lady informed me that appointments were in 20-minute intervals and gave me my slot.

We arrived. Knock on the door. No answer. Press the buzzer. No answer. OK, walk in and you’re confronted by six closed doors leading off a passage. Ah! “Salle de attendee” on one door – waiting room.

Enter – not a soul in sight. The waiting room was not different to anyone in the world: ages old magazines (but being France, they were Vogue); coffee and tea on tap and posters informing you that if you have an injection or you do not feel well after seeing the doctor, you may take a taxi home and the French government will pay for it – and for you to return to collect your car, when you’re better!

Door opens. Doctor arrives. Very pleasant, charming and eloquent in English.

We go into his consulting room via the closed door passage and it is no different from any other. However, off the room is a mini-surgery where rural doctors do procedures. All fully fitted out and supplied by the Government.

After I have listed my health woes, he taps on his computer and says “what’s my base line?” (Haven’t heard that one before).

The base line turned out to be:

1. Blood tests
2. Treat the pain and swelling
3. Get rid of the virus

Transaction completed. Your receive your account (pay cash), insurance forms, script all from the doctor’s friendly little laptop (complete with French govt flag) – no receptionist or nurse in sight and you leave by another door, away from the waiting room. Consultation: E22.00 (AU$35.55; ZAR251.00)

So, off I went to the pharmacy. Your prescription form is in duplicate – in France the patient/customer must have a copy of everything about you given to another party. You are given your medication.

The pharmacist writes the dispensing instructions in flowing cursive on the box with a texter – what? No expensive computer labelling system, I ask. “Non! – why, the patient can read the box (the package insert is left in as well)!” You pay cash and the register also spits out the insurance form. All very neat – the forms are not recognised unless the barcode pricing label from the box has been placed on the form for verification purposes. A bespoke labelling system with peel off makes it pretty easy.

Prices are controlled and at cost. For example, Doxy 100 Ge (doxycycline) for 30 days (2x day) is E7.50 (AU$12.11; ZAR85.58)

Another quirk of the French healthcare system is that analgesics are only available in pharmacies (privately owned) or parapharmacies (often owned by the big supermarkets) but not in supermarkets or convenience stores. Price controlled, too. And, as the doctor remarked, we only use one – Dafalgan 500mg (paracetamol) – because what is the use of a paracetemol if it doesn’t cure a Frenchman’s head the morning after with a coffee and a nice croissant? Nice contract for Bristol-Myers Squibb.

Blood tests. Off to Coustellet.

After minimum formalities, you are ushered into the blood-sucking chamber. In France, the person who analyses your blood must be the one to take the blood. Therefore, I have the consulting pathologist himself.

A nifty little gadget was an electric rocker to keep the blood moving as other phials were filled. The Doctor keeps up a little patter – ‘my patients must be calm’, he tells me. He claims that France is the only country to use the rocker so as you can care for the patient and not worry about ‘the health of the blood’. Nice touch.

My blood was taken at 09h00. By 12h00, the results were accessible via my own personal code on their website to both my doctor and myself (the law again: I must be able to see what the doctor can see).

Efficient payment, insurance forms printed out. Cost of procedure: E26.00 (AU$42.00; ZAR296.00)

Regulation or de-regulation? The question in vexing. This was a great example of a highly regulated environment working to perfection. However, was it the people making it work? I think so.”

• Simon Burrow trained as a schoolteacher and journalist before embarking on a career in health and beauty retailing for over twenty years. He is now consulting, predominantly in health and beauty, and works in Australia, India, Singapore, South Africa and France.

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