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August 11, 1993, Vol 270, No. 6 >
ARTICLE | August 11, 1993

Lessons From France—'Vive la Différence': Title and subTitle BreakThe French Health Care System and US Health System Reform FREE

Jonathan E. Fielding, MD, MPH; Pierre-Jean Lancry, PhD
[+] Author Affiliations

In alphabetical order, from the Department of Health Services, UCLA School of Public Health, and Department of Pediatrics, UCLA School of Medicine, Los Angeles, Calif (Dr Fielding), and the University of Paris XII and CREDES (Centre de Recherche, d'Étude et de Documentation en Economie de la Santé), Paris, France (Dr Lancry).

Reprint requests to UCLA School of Public Health, Department of Health Services, 31-236 CHS, 10833 Le Conte Ave, Los Angeles, CA 90024 (Dr Fielding).


JAMA. 1993;270(6):748-756. doi:10.1001/jama.1993.03510060094040
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References

GERMANY, and Canada, maybe England. These countries are where US policy makers look for lessons applicable to reform of the US health care system. Why not France? France provides almost universal coverage with a uniform comprehensive benefit plan that, unlike those in the United States, includes pharmaceuticals, physical therapy, and even medically prescribed spa treatments. Consumers have coverage that follows them from job to job, including any intervening periods of unemployment. Out-of-pocket costs are capped below the level where they could cause financial hardship. There is free choice of office-based physicians and ancillary service providers for ambulatory care.

France spent 9.1% of its gross domestic product (GDP) on health care in 1991, similar to Canada (10.0%) and Germany (8.5%) but over 4 GDP percentage points less than the United States at 13.4%.1 Yet life expectancy in France at 81.1 years for women and 73.0 years for men in 1991

REFERENCES

1 +
Schieber G, Poullier J-P, Greenwald L.  US health expenditure performance: an international comparison and data update. Health Care Financ Rev . 1992;;13:1-15.
2 +
Blendon RI, Leitman R, Morrison I, Donelan K.  Satisfaction with health systems in ten nations: Harvard-Harris-ITF, 1990, Ten-Nation Survey. Health Aff . 1990;;9:185-193.
3 +
 Pursuit of health systems reform. Health Aff . 1991;;10(theme issue):4-245.
4 +
Rodwin VG.  The marriage of national health insurance and la medicine liberale in France: a costly union. Milbank Q . 1981;;59:17-43.
5 +
Godt PJ.  Doctors and deficits: regulating the medical profession in France. Public Adm Rev . 1985;;63:151-169.
6 +
Wilsford D.  The cohesion and fragmentation of organized medicine in France and the United States. J Health Polit Policy Law . 1987;;12:481-503.
7 +
Rodwin VG.  On the separating of health planning and provider reimbursement: the US and France. Inquiry . 1981;;18:139-150.
8 +
Caisse Nationale de l'Assurance Maladie. La CNAMTS en quelques chiffres . Paris, France: CNAMTS; 1992;.
9 +
Hospital Statistics, 1991-1992 . Chicago, Ill: American Hospital Association; 1992;.
10 +
Ministry of Social Affairs. Circular 5333. Paris, France: Hospital Directorate; December 10, 1987.
11 +
Enquete hospitalisation privée . Paris, France: Ministère des Affaires Sociales, Service des Statistiques, des Études et des Systèmes d'Information; 1992;.
12 +
Caisse Nationale de l'Assurance Maladie. Indicateur Statistique . Paris, France: CNAMTS; 1991;.
13 +
Jullien D, ed. Lamy social, droit du travail, securité sociale . Paris, France: Lamy SA; 1992;.
14 +
Bocognano A.  Evolution de la protection sociale entre 1980 et 1990. CREDES . 1992;. No. (913) .
15 +
Devevey J, Hum C. Quarante ans de statistiques en assurance maladie . Paris, France: CNAMTS; 1985;. Bloc-notes No. 18.
16 +
Lamiot D, Lancry P-J. La protection sociale, les enjeux de la solidarité . Paris, France: Nathan; 1989;.
17 +
Liaisons sociales . Paris, France: Barème Social Périodique; 1993;.
18 +
Employer Costs for Employee Compensation . Washington, DC: US Dept of Labor, Bureau of Labor Statistics; 1992;.
19 +
 Sécu: ce que veulent les français. Impact Med . (October 15) , 1992;.
20 +
Bocognano A, Grandfils N, LeComte T, Mizrahi A, Mizrahi A. Enquete sur la santé et la protection sociale en 1991, premiers resultats . Paris, France: CREDES; 1992;. No. 934.
21 +
Lancry P-J.  Le secteur 2 de la médicine liberale, un élément de marché? Rev Econ Pol . 1990;; 99:854-870.
22 +
Sandier S. Activité et recettes des généralistes en secteur 2, premiers résultats . Paris, France: CRE-DES; 1992;. No. 938.
23 +
Caisse Nationale de l'Assurance Maladie. Atlas des zones d'ombre . Paris, France: CNAMTS; 1993;. Bloc-notes statistique No. 64.
24 +
Vell S. Plan de redressement de l'Assurance Maladie. Press conference given by the minister of social affairs, June 29, 1993, Paris, France.
25 +
Poullier J-P.  Administrative costs in selected industrialized countries. Health Care Financ Rev . 1992;;13( (4) ):167-172.
26 +
Nombre de Places Mises au Concours de l'Internat: Texte officiel du Conseil National des Concours de l'Internat . Paris, France: Ministére de la Santé; 1993;.
27 +
Meyer C, Lancry P-J, Vedrine M. Investir dans la gestion du système de santé . Paris, France: Documentation Française; 1989;:220-352. Report of the Commission Protection Sociale du Xème Plan.
28 +
Loth A.  Le PMSI, notions fondamentales et orientations. Lett Inf Hosp Lett Syst Inf Méd . 1991;; 7:1-4.
29 +
Devevey J. La clientèle des médecins . Paris, France: CNAMTS; 1989;. Bloc-notes No. 45.
30 +
Hospital Statistics, 1989 . Chicago, Ill: American Hospital Association; 1989;.
31 +
Lancry P-J, Fagnani F. Evaluation economique du dépistage systématique des cancers du sein et du col de l'utérus . Brussels, Belgium: Commission des Communautés Européennes COMAC-HSR; 1989;:61.
32 +
Brown ML, Kessler LG, Rueter FG.  Is the supply of mammography machines outstripping need and demand? Ann Intern Med . 1990;;113:547-552.
33 +
1992 NABP Survey of Pharmacy Law . Champaign, Ill: National Association of Boards of Pharmacy; 1992;.
34 +
Moreaux C.  Droit de substitution, les syndicats s'opposent. Pharmaceutiques . 1992;;1:49.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Schieber G, Poullier J-P, Greenwald L.  US health expenditure performance: an international comparison and data update. Health Care Financ Rev . 1992;;13:1-15.
2 +
Blendon RI, Leitman R, Morrison I, Donelan K.  Satisfaction with health systems in ten nations: Harvard-Harris-ITF, 1990, Ten-Nation Survey. Health Aff . 1990;;9:185-193.
3 +
 Pursuit of health systems reform. Health Aff . 1991;;10(theme issue):4-245.
4 +
Rodwin VG.  The marriage of national health insurance and la medicine liberale in France: a costly union. Milbank Q . 1981;;59:17-43.
5 +
Godt PJ.  Doctors and deficits: regulating the medical profession in France. Public Adm Rev . 1985;;63:151-169.
6 +
Wilsford D.  The cohesion and fragmentation of organized medicine in France and the United States. J Health Polit Policy Law . 1987;;12:481-503.
7 +
Rodwin VG.  On the separating of health planning and provider reimbursement: the US and France. Inquiry . 1981;;18:139-150.
8 +
Caisse Nationale de l'Assurance Maladie. La CNAMTS en quelques chiffres . Paris, France: CNAMTS; 1992;.
9 +
Hospital Statistics, 1991-1992 . Chicago, Ill: American Hospital Association; 1992;.
10 +
Ministry of Social Affairs. Circular 5333. Paris, France: Hospital Directorate; December 10, 1987.
11 +
Enquete hospitalisation privée . Paris, France: Ministère des Affaires Sociales, Service des Statistiques, des Études et des Systèmes d'Information; 1992;.
12 +
Caisse Nationale de l'Assurance Maladie. Indicateur Statistique . Paris, France: CNAMTS; 1991;.
13 +
Jullien D, ed. Lamy social, droit du travail, securité sociale . Paris, France: Lamy SA; 1992;.
14 +
Bocognano A.  Evolution de la protection sociale entre 1980 et 1990. CREDES . 1992;. No. (913) .
15 +
Devevey J, Hum C. Quarante ans de statistiques en assurance maladie . Paris, France: CNAMTS; 1985;. Bloc-notes No. 18.
16 +
Lamiot D, Lancry P-J. La protection sociale, les enjeux de la solidarité . Paris, France: Nathan; 1989;.
17 +
Liaisons sociales . Paris, France: Barème Social Périodique; 1993;.
18 +
Employer Costs for Employee Compensation . Washington, DC: US Dept of Labor, Bureau of Labor Statistics; 1992;.
19 +
 Sécu: ce que veulent les français. Impact Med . (October 15) , 1992;.
20 +
Bocognano A, Grandfils N, LeComte T, Mizrahi A, Mizrahi A. Enquete sur la santé et la protection sociale en 1991, premiers resultats . Paris, France: CREDES; 1992;. No. 934.
21 +
Lancry P-J.  Le secteur 2 de la médicine liberale, un élément de marché? Rev Econ Pol . 1990;; 99:854-870.
22 +
Sandier S. Activité et recettes des généralistes en secteur 2, premiers résultats . Paris, France: CRE-DES; 1992;. No. 938.
23 +
Caisse Nationale de l'Assurance Maladie. Atlas des zones d'ombre . Paris, France: CNAMTS; 1993;. Bloc-notes statistique No. 64.
24 +
Vell S. Plan de redressement de l'Assurance Maladie. Press conference given by the minister of social affairs, June 29, 1993, Paris, France.
25 +
Poullier J-P.  Administrative costs in selected industrialized countries. Health Care Financ Rev . 1992;;13( (4) ):167-172.
26 +
Nombre de Places Mises au Concours de l'Internat: Texte officiel du Conseil National des Concours de l'Internat . Paris, France: Ministére de la Santé; 1993;.
27 +
Meyer C, Lancry P-J, Vedrine M. Investir dans la gestion du système de santé . Paris, France: Documentation Française; 1989;:220-352. Report of the Commission Protection Sociale du Xème Plan.
28 +
Loth A.  Le PMSI, notions fondamentales et orientations. Lett Inf Hosp Lett Syst Inf Méd . 1991;; 7:1-4.
29 +
Devevey J. La clientèle des médecins . Paris, France: CNAMTS; 1989;. Bloc-notes No. 45.
30 +
Hospital Statistics, 1989 . Chicago, Ill: American Hospital Association; 1989;.
31 +
Lancry P-J, Fagnani F. Evaluation economique du dépistage systématique des cancers du sein et du col de l'utérus . Brussels, Belgium: Commission des Communautés Européennes COMAC-HSR; 1989;:61.
32 +
Brown ML, Kessler LG, Rueter FG.  Is the supply of mammography machines outstripping need and demand? Ann Intern Med . 1990;;113:547-552.
33 +
1992 NABP Survey of Pharmacy Law . Champaign, Ill: National Association of Boards of Pharmacy; 1992;.
34 +
Moreaux C.  Droit de substitution, les syndicats s'opposent. Pharmaceutiques . 1992;;1:49.

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