Access to healthcare in France is not determined by civil or employment status, or by one’s ability to wrangle down affordable health insurance. All citizens, regardless of pre-existing conditions, are covered by the government-run Sécurité sociale (Social Security). It is perhaps for this reason that the French have the highest life expectancy in Europe, and one of the highest in the world. It is also probably the reason behind their reputation as the highest consumers of psychotropic medication of the European Union. Indeed, when a visit to a general practitioner costs on average 25Euros, 70% of which is reimbursed by Social Security and most pharmaceuticals are reimbursed at 70%, there’s little incentive to economize on treatment.

Yet citizens do pay for their treatment through monthly taxes taken directly out of their paychecks and annual income tax returns. The unemployed, students, and those making under 30K are exempt from the annual Social Security tax. And conversely, those making over 100,000Euros per year will see approximately 16% of their income go to Social Security.

France spends approximately 11% of its GDP on healthcare annually, considered to be one of the highest health budgets in Europe. However, compared to the U.S., which spends nearly 16% of its GDP on healthcare while still leaving millions without coverage, France’s expenditure for universal coverage seems more than reasonable. 76.6% of healthcare and medical expenses are financed by Social Security, private and mutual insurance companies cover 12%, and individuals pick up the remaining 11.3%.

The French government acts as employer, educator and regulator of all healthcare workers and officials in France, and in particular, of the office of Social Security. The Ministère de la Santé, currently directed by Roselyne Bachelot, oversees the prevention and care of major health issues – drug addiction, obesity, and most recently swine flu – by establishing and regulating medical standards. Members of Parliament meet annually with the medical community to identify public health concerns and create a coordinated response.

The impetus for such a system is not purely altruistic; it is understood that social cohesion – that famous concept of Liberté, Egalité, Fraternité – and financial stability are intrinsically linked to the physical and psychic wellbeing of a nation. Of course, the French healthcare system does not come without its drawbacks. The most obvious and sensitive issue that rankles the French remains the fact that those in the highest income bracket finance the healthcare of illegal immigrants, permanent welfare beneficiaries, and citizens who refuse employment. The state regulated doctor fee keeps treatment prices low for all, but also allows for what some consider abuse of the system. Additionally, since the state does not reject coverage to consumers with pre-existing conditions or lifestyle choices that result in secondary illness and require expensive healthcare, citizens who rarely benefit from the healthcare system may pay the same in income taxes as those who are in need of constant care.

In January 2008, I discovered that I was pregnant with acardiac twins. Only one fetus was viable. Yet due to an umbilical chord complication, our baby risked dying of cardiac stress in the later term of my pregnancy. Desperate to do whatever it took to save its life, my husband and I agreed to a revolutionary intra-uterine surgery that would separate the twins’ umbilical chords, allowing the viable twin to survive.

Though the operation went smoothly, five days later a follow-up sonogram proved what we’d dreaded – the viable fetus’ heartbeat had stopped. I returned to the hospital the following day for a 3-day visit, during which I was given a spinal block, induced, and finally delivered our twins at 17 weeks of pregnancy. After delivery, I was prescribed a number of post-partum medications, and offered psychological care.

The total cost of all services rendered – from the time the anomaly was detected to the many sonograms taken prior to surgery, the surgery itself, all treatment, medications received during both hospital visits, and the optional psychological visits – came to 37Euros. The rest was paid for by Social Security.

Today, as we excitedly await the arrival of a healthy baby, I’ve put most of the pain of losing twins behind me and look to our family’s future with optimism and joy. I wonder, though, if we’d been in a country where we didn’t have private health insurance, or if our insurer refused to cover the hospital care that we were advised to have, would we still be paying off the debt of that care? Would moving forward through the grieving process have been compounded by the stress of paying off healthcare debt? Or would we have decided to forgo the surgery, and hope for the best, putting both the baby’s and my life at risk?

Aralena's article is part of our series that examines the benefits and drawbacks
of various healthcare models around the world. - Ed.

About the Author
Aralena Malone-Leroy is the News Editor for The WIP, as well as a contributing writer.

Aralena earned her Bachelor of Arts Degree in French and International Studies from Santa Clara University, and a Masters Degree in Mass Communications and Journalism from San Jose State University. Her interest in foreign politics and cultures brought her to Paris, France for research in Diplomatic Studies at the University of Westminster, and Religious Studies at the Institut d'Etudes Religieuses.

She nourishes her passion for travel, writing and humanitarian efforts through work in public relations in the private and non-profit sector. As an active member of the LAAFI Association, a French NGO dedicated to improving education in Burkina Faso, Aralena handles the association's marketing and outreach literature.