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Yesterday I went to see a doctor, and it made me think of how differently Danes and Frenchmen deal with health issues. Now I cannot be sure to be a good representative of the Danish population, wherefore what follows can only be a comparisson between me and the Frenchmen I have met.
My mother is a nurse, and as a child I had to be seriously ill before a doctor was deemed necessary. Thus between the early childhood vaccinations and the doctor's certificate to get a driver's license at the age of 18, I only recall seeing the doctor once. I was 10, was suspected of suffering from meningitis and was hospitalised for a week due to a double sided pneumonia. Apart from that I saw the doctor at school once a year to check my eye sight and my weight (a delicate issue all through my childhood, admittedly), and that was it. I was probably lucky as a child as I never suffered for anything more serious than a cold or a flu, which meant that I stayed in bed for a day or two, drinking hot milk or tea, and eating liquorice. Then it was back on the bicycle and off to school. Perhaps this is the reason for my thinking that doctors and medicine are only for serious illnesses?
In France it is an entirely different story. As I see it there are several explanations for this:
A typical Frenchman will wake up with a sore throat and start worrying: if I don't do something about this sore throat, it will turn into a cough and a bronchitis, or I will get a cold followed by a sinusitis or even worse. Encouraged, perhaps even pushed, by the colleagues, who all have an impressive knowledge about illnesses and treatment options, the Frenchman will then call the GP for an appointment the same day. The doctor will find it entirely natural that a patient asks for an appointment due to a sore throat and will give the patient his full attention which means that the patient will leave with a prescription for an average of five kinds of medicine: pain killers, sirup, nose spray, anti-biotics, etc, etc.
Now imagine a Frenchman who has got a pain somewhere else, say the hand or wrist or back or head. Again, he will get a doctor's appointment the same day or perhaps the next day, and this time the doctor will add to the list of painkillers a blood test, an X-ray, a scan, an IRM, etc. Once the results have been obtained, the Frenchman will return to the GP, and then follows a list of medicine or a referral to a specialist. The thing is that French doctors don't say no. It is not like they are afraid of being sued; they just don't seem to be able to tell a patient to go home and get some rest. Patients expect medicine, and doctors find it easier to just give what the patients expect.
Let's then imagine that a Frenchman is sick and feels unable to go to work. Even if the Frenchman decides that he does not need medicine, however unlikely that is, he will be obliged to see a doctor to obtain a doctor's certificate for sick leave to be provided to his employer and the social security. In France you have to provide a certificate from a doctor even if you just have a simple cold or a hang-over or a migraine. There is no way around it. And though you provide the certificate, you don't get paid! You will have between one and three days where the social security does not pay you anything. In many private companies, however, the employer pays you anyway. However, it is not automatic. For a Dane or an Englishman or a Dutchman this will come as a complete surprise. So it did for me when my colleague told me that he got a short payment last month after having been off sick for three days after an operation.
What are the financial aspects? French doctors seem to work incredibly long hours, like from 7:30 am to 9 pm. They squeeze in as many patients as possible, as they are paid per consultation. The standard rate per consultation is €23 (this is what is called "Secteur 1"), but doctors are free to charge whatever they like, as long as patients are informed on a paper posted in the waiting room. These higher rates are called "Secteur 2". For the doctor it means more money in the bank; for the patient it means less reimbursement from the social security. Who pays the difference between the actual charging rate and the reimbursement by the social security? It is the patient, except that in most cases the patient will have a health insurance via his job, and this insurance will pick up the bill. Consequence: if you don't have a job and/or a health insurance, you will not be able to pay the higher "secteur 2" charge, and as more and more doctors charge the higer rate because they are unhappy with the standard rate, it becomes more and more difficult to find a good doctor who charges the standard rate.
Let's get some figures on the table. Due to the heavy use of the health system the deficit on the social security budget is obviously enormous. Something like 13.1 billion euros in 2012 which I presume is the difference between the social security deductions from our gross salary and the actual expenses. A private health insurance such as the one I have via work costs for a single person about €80 or €90 per month of which I pay half. The GP I saw yesterday charged me €40, but I expect to be nearly 100% reimbursed by the social security respectively the health insurance. There is, however, a one euro deductible to discourage people from abusing the health system.
Let's see how my encounter with the French health system develops and how much it will cost me, the social security and my health insurance. This week I paid €40 to see a GP and €90 to get an X-ray of my feet. Next week I will go back to the GP for her decision on what further action to take in accordance with the X-rays that are now lying in my drawer at work. Here is a picture of my right foot: any guesses what is wrong???
