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(This
column by Harriet Welty Rochefort© was published in The
ParisPages
July 2000)
PARIS--A recent front page article
in the International Herald Tribune announced that the World
Health Organization, which for the first time in its history
ranked the health systems of its 191 member countries, rated
France first on the list for providing the best overall health
care.
As I read the article, I found
myself looking back on some thirty years of health care in France.
My family and I have been fortunate not to have had any major
illnesses (I knock on wood as I write this) so the doctoring
we have had mostly concerns the joyful (pregnancies) and the
mundane (colds). Having paid into and benefited from the French
system for the past three decades, I can confirm that the system
is indeed a good one.
In my first years in France,
of course, there were a few things I didn't understand. I didn't
know that when you go to the doctor in France, you pay him right
there in his office rather than waiting for the bill. I learned
this after walking out without paying once - the doctor's astonished
look told me something was awry.
I didn't know that after the
visit, when you go to get the medicine, you present your prescription
along with the Social Security form on which the pharmacist writes
down what you purchased and the price. The next step (back home
unless you've got a nice pharmacist who will do it for you) is
that you take the little stickers off each box and paste them
on to the Social Security paper which now contains the following
information: the cost of your consultation and your doctor's
signature and the date of your visit to him, the date of your
visit to the pharmacy and the names and cost of the medicine
you bought PLUS the little stickers from each and every box of
single medicine as proof. In the beginning I thought this was
silly and didn't do it. After losing all kinds of money on medicine,
I decided that it might be time-consuming but certainly worth
the effort.
I learned that the French have
different illnesses than we Americans have. For example, when
Americans are feeling lousy due to too much heavy food or drink,
they say they have a "stomach ache". (If it's too much
drink they say they have a hangover - in France this is called
a "gueule de bois" but of course you wouldn't tell
your doctor that!) The French have "mal au foie" (liver
ache). I didn't even know I HAD a liver until I got to France!
I rapidly got used to all of
the above and it didn't take me long - especially after I had
children - to become a fan of the French health care system.
Sure, not everything is perfect in France. There are incompetent
doctors, arrogant doctors, doctors who overprescribe, doctors
who underprescribe, frustrated nurses, hitches and glitches in
the bureaucratic Social Security system. But all in all, if you've
got to be sick, France is one of the best places to be. And here,
in my book, at least, is why:
--Whenever either of my children
were running high fevers, I automatically called the doctor who
came to the house. It never even crossed my mind to wrap the
child up in a blanket and go sit in some waiting room until the
doctor was available. The child stayed warm in his own bed until
the doctor arrived. There's only one word for this and it's called
"civilization". (I just hope the French will continue
to do this. When I was a child in the States, doctors paid house
calls as well-ah, the good old days). The charge was slightly
higher for the house call, but not significantly. Social security
and my husband's "mutuelle" (complementary insurance)
paid for 99 per cent of the visit.
--The side benefits of the doctor
coming to you is a human quality which can sometimes be endearing.
I once had a doctor who strummed on our guitar, thankfully, AFTER
diagnosing our ills; another doctor, a friend of ours, is so
popular that when he makes house calls he can barely make it
from one place to another. "Pierre, you must join us for
an aperitif-you can't go yet!" One reason for this is that
in addition to being a good doctor and a great storyteller, Pierre
thinks nothing of climbing up on a ladder to change a light bulb
or get down under the sink to try to find the origin of a leak.
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--Both
times I was pregnant, I gave birth in French hospitals where
in addition to excellent medical treatment, I was given total
rest. Each time I was kept eight days!! I must admit that for
the second child I was itching to get home. But for the first
baby I was happy to be coddled and to put off the moment when
I would find myself responsible for this new little creature.
Not only that, but the hospital in which I gave birth to my firstborn
(the university hospital in Nantes) was spanking clean and served
excellent food AND red wine with the meals!! As you may know,
the French think red wine (RED, not white, and Bordeaux more
than any other red) is good not just for every ill that could
assail the human body but also for the morale. It certainly was
good for mine! My second son was born at the Hôpital Salpetrière
in Paris. The rooms were not exactly out of Architectural Digest
painted as they were in yukky shall-I-slit-my-throat-now-or-later
green and there was no time for the coddling I got at the University
Hospital in Nantes. But, as my husband reminded me, if anything
serious went wrong with either me or the baby, I was in a place
with the finest emergency equipment available and could be taken
care of right on the spot.
--In France, a factory worker
and a head of a company can see the same "grand professeur
de medicine": the factory worker will pay one price, the
company head another. (By the way, in France you choose your
doctor, you are not "assigned" to one). Recently my
generalist told me I should get a cardiogram just as a matter
of routine since I'd never had one. I could have gone to any
doctor but decided to go to the Hôpital Broussais to see
an eminent heart specialist who over the past twenty years has
taken excellent care of friends of mine with grave heart conditions.
This was, in fact, a very stupid decision as any doctor could
have looked at my (perfect) results and told me
I was fine. By the time I realized this, though, I was already
at the hospital and it was hard to leave. I
watched in horror as people with obviously major problems were
ushered in and out; I was ashamed of being in such good health!
A technician did the cardiogram and then I was ushered into the
Professor's office. He examined me thoroughly, questioned me
about my family history (bad news in the heart department).
"I'm afraid I can't do anything
for you," he told me, shaking his head kindly. "Your
heart is perfect - at least, it's perfect today!" he said.
What he didn't say is that it was probably the first time in
decades that he'd seen someone who is perfectly healthy. Oh well,
it comforted me to know that anyone in France can benefit from
superior care like this without it costing an arm and a leg,
pardon the pun. The bill for the cardiogram and the consultation
with this specialist(whose rank would be the equivalent of the
Head of the Cardiology Department at the Mayo Clinic) came to
320 French francs (about $46.00).
--Life expectancy is tops (France
ranks first
in life expectancy - the U.S. ranks 37th). One of the reasons
for this discrepancy may be that almost everyone in France has
health insurance and therefore access to care. But there may
be other reasons: In the "Letters to the Editor" section
of The Herald Tribune, Samir Sanad Basta, the former director
of Unicef Europe pointed out some of the contributing factors
that the WHO did not mention in its study. It just may be, Basta
wrote, that "tasteful diets, extramarital sex, grumbling,
yelling, red wine, smoking (especially for teenage girls), tax
evasion and work stoppages" all contribute to long lives.
His tongue-in-cheek conclusion: "All is not health care
or medicine!"
I thought of one more "contributing
factor" to longer life expectancy: gun control. The French
may grumble, threaten each other, yell, raise their shoulders
and cast dark menacing looks but they don't blow each other away
everytime they get into a dispute (if they did, there would be
no more Frenchmen in France). They can't, because access to guns
is so severely limited. Voilà another reason the French
live long enough to enjoy all that delicious food and drink (while
smoking, naturellement).
Vive la France. Vive the paradoxical
French!
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