I used to work for a physician group (while I was in College) as well as a medical insurance company (7 years+). I really think this system is great...there are a few flaws and minor things I find annoying but overall I believe it's pretty great! And even if you live in France and are not privy to the socialized healthcare (know as Assurance Maladie) you ARE privy to the low costs! The prices are a fraction of the costs compared to the US.
Take for instance the price of an inhaler. In the US it was $80 (total price to the insurance company from the pharmacy) in France the same exact brand, dosage etc..was the equivalent to $15! Why? Because the pharmaceutical companies charge the US insurance companies and citizens more for the same products than here in France/UK etc...
NOW Michael Moore did not get it completely right...here the real story is that we DO pay for our physician fees up front (not pharmacies or labs). Coming from a medical/insurance background I think this is excellent for the physician. They get paid when they perform their service instead of filing the claim to the insurance on behalf of the patient and waiting 30-90 days to receive payment. For an American this would be really weird and even unfair in our minds...but really it's not. Why should a doctor wait to be paid for a service they performed over a month ago? And sometimes they never even get paid! I have seen it first hand...insurance companies look for loop holes, set filing deadlines, deny for filing errors/authorization errors etc...anything to save a buck here and there.
So the way it works...when we go to the doctor he collects the money and either gives us a form to send to Assurance Maladie OR swipes our social security card and sends the request for reimbursement electronically. For Pharmacies and Labs it's all electronic. For Hospitals it is electronic except for added perks (TV, Single Rooms) and the Physician Fees at the hospitals are handled the same as all other Physician fees.
Paper filing of course takes AGES! 6 weeks to be exact...yes 6 weeks to get your reimbursement!
Electronic Filing takes 3 days for the funds to be deposited automatically into your bank account. Sounds awesome huh? Well it would be except for many doctors DO NOT do this. Why you say?
It's because most doctors especially here in the city (usually those who have extra training) can charge higher rates rather than the base rates (which is what the gov't will ONLY pay and sometimes the gov't only pays a % of the base rate for many different reasons). Electronic filing CAN NOT be done IF they charge more than the base fees. I find this REALLY annoying. I don't understand why they can not send the base rate fees electronically and then also do a paper form for the remaining fees. It's the way it is though. Maybe they will change this someday as electronic is far more efficient.
We have an added secondary insurance which is called a Mutuelle...and is very common here. The Mutuelle is to pay for the remaining doctor fees (and for the % of the base fees Assurance Maladie did not pay for). My husband's employer actually requires all employees to have it. Of course our two most common visited physicians these past 2 years are those types of physicians who charge more than the base rate (by choice of course). So its awesome, after all reimbursements we normally do not end up paying anything (exception was for the birth of Little Miss...I will explain later).
So it's fairly simple. Electronic or Paper once the government pays their portion (deposited into our bank account) the remaining fees are automatically transmitted to our Mutuelle. It usually takes them about 3 days to deposit their portion into our bank account. So from start to finish it is 6 -8 days from time of service/payment for electronic filing vs. 6 weeks + 3/6 days for paper filing to receive all reimbursements.
During the pregnancy and the birth of Little Miss I had to keep a list of all doctors visits, ultrasounds and everything else out of pocket. It was a bit confusing but we got through it. There was added complication due to Little Miss was not added to the gov't plan and our Mutuelle (of course it just takes time like other insurances). So we had some waiting to do but it all cleared up.
The entire labor and delivery cost 3500 euros total! The Hospital received 900 euros (3 days x 300 euros), OB/Midwife 1900+ euros, Pediatrician 53 euros x 2 visits and Anesthesiologist 500+ euros. Versus $28,000 is what Little Man's labor and delivery cost my US insurance. Now MAYBE the hospital charges their fees directly to the state and I do not see them (it's possible). But they are not on my account any where. I tried to search online if they do...but I couldn't find any information on it. So I believe this is IT! Amazing huh? We did have an out of pocket fee of 2600 euros the day we were discharged from the hospital. After our Mutuelle reimbursed us we were only responsible for 546.48 euros because we wanted a private deluxe room (vs a double occupancy or private standard room) and 346 euros because we opted to have our own Midwife (+ OB/GYN) vs. a Midwife from the hospital. We did not want to risk getting a Midwife who did not speak English. I can speak French and my husband is French but when having a baby I didn't want to worry about it. All of these fees were PERKS. If we did not opt to have these added luxuries it would have been completely free.
Below are the typical physician fees, how much the base fees are and the actual reimbursed amount by the govt...IN EUROS (I did not include lab fees or pharmacy...as they are so varying depending on the type of lab or drug but it's minor):
- Consultation Pediatrician - Doc Charged 75, Base Fee was 23, AM reimbursed 16.10
- Consultation OB/GYN - Doc Charged 90, Base Fee was 23, AM reimbursed 23
- Consultation General Phy - Doc Charged 30-45, Base Fee was 23, AM reimbursed 16.10
- Consultation Ped in Hosp - Doc Charged 53, Base Fee was 23, AM reimbursed 23
- Consultation Eyes Child - Doc Charged 44, Base Fee was 23, AM reimbursed 16.10
- Ophthalmologist Adult - Doc Charged 49, Base Fee was 40.95, AM reimbursed 28.66
- Ultrasounds Child (multi) - Doc Charged 96/110, Base Fee was 75.60/56.70, AM reimbursed 52.92/39.69Ultrasounds Preg (had 3 tests) - Doc Charged 70/150/180, Base Fee was 48.35/73.99/81.92, AM reimbursed 23.85/73.99/81.92
Remember we have a secondary insurance who pays the remaining fees (i.e. for the first visit above we paid 75 euros was reimbursed 16.10 then our Mutuelle paid the remaining 58.90!). There are plenty of cheaper doctors out there...we just happen to go to VERY expensive doctors. I just feel more comfortable with our French Pediatrician who is fluent in English and is a member of the AMERICAN Board of Pediatrics!
I will say that the majority of parents I know see a General Practitioner (Family Physician) vs a Pediatrician. A Pediatrician is considered a specialist and here their kids don't generally keep going to one very long or at all.
I will have to Part 2 as I am unsure about the cost of our Mutuelle and our Social Security (for Healthcare) monthly. But I believe we are benefiting here vs in the US (esp since we are going to the doctors so much these past 2 years). The reason I am not sharing how much it costs is really simple The French Paycheck is VERY hard to read...it's literally 4 pages long (full of line items)...NO JOKE! I will consult with my husband and do another post about the costs per month. I will also add in that post what else is taken out. And our other benefits here there are tons!
Now to be clear about one more thing...all doctors take the Assurance Maladie no matter what. There is no in network/out of network. And your Mutuelle will pay for the remaining fees IF and only if Assurance Maladie has a base fee for it. If it is not a covered item take for instance my diabetes glucose test. The diabetes glucose test was covered BUT not the sugary drink I had to take in order to take the test. Yes the drink was 1 euro but I found that really weird.
I hope this helps and answers any questions you might have about our famous or should I say infamous healthcare system ;-)
Do you agree with socialized medicine? Would you like to see the US adopt some sort of system like France, UK or Canada? What experiences do you have with insurance companies and payment or lack there of? What prejudices do you have with socialized healthcare or misconceptions? Do you find it too intrusive? Or a relief? Comments welcome ;-)