Thursday, February 16, 2017

French vs. American Healthcare

Advantages of the French Medical System:
  • There doesn't seem to be any cost-benefit analysis done.  If there is a risk, even minor, that you could die of a blood clot, they will treat you.  Update: they also do not wait for you to have a life-threatening reaction before prescribing an EpiPen equivalent.  If you have a food allergy that causes respiratory issues, they prescribe it - as the doctor noted, the reactions are often progressive and you could easily die before medical services reached you.
  • Even uninsured medical costs are so low that I mistakenly thought they were my post-insurance rate.  Twice.  23 Euro for an uninsured doctor's visit?  88 Euro for DAILY injections at home by a nurse for two weeks?  Oh right - attending university is free here, so they don't need to pay college-educated people crazy high salaries just to afford their student loans . . . that's one way to keep the gap between "rich" and "poor" narrower for sure.  There is a premium paid for college-educated people (you still invest your time after all), but it isn't nearly as large as in the US.  This is also NOT a for-profit system, so every level of the medical industry doesn't need to carve out their profit at levels that satisfy shareholders.
  • While I pay A LOT of taxes, the overall percentage for somebody like me is not actually that much different from what I paid in the US, plus my health care premiums, plus the FSA to be certain I could always foot the 20% that my insurance didn't cover, plus the higher amount I needed to save for retirement because health care costs are one of the big spend categories for US retirees . . . basically, the difference in France is that many people pay a little more in taxes, but then everyone is also covered if the worst happens.  You aren't likely to lose your house here because you get sick or injured.
  • They prioritize your health.  I could have easily chosen to spend the last 3 weeks off work with nearly full pay.  Except, I didn't really feel it was necessary with my job and it would have hurt my plant to go through close and year-end adjustments without their only local finance person.
  • The doctors actually explain stuff to you.  They tell you not only that they've determined you injured a ligament, then later, probably tore the meniscus, but also that it was this particular test where they moved your leg in this or that way which told them what the problem was.  It inspires a certain level of confidence in the diagnosis when the doctor openly tells you how they drew that conclusion.
  • If you tell a French person that you're calling on Wednesday for an appointment the following Monday, they will be shocked because you're calling so EARLY.  Apparently, there must be a much better per-capita number of doctors here than the US if a few days notice gives you your choice of appointment times.
  • Doctors will make house calls, if necessary.
  • If you can't drive, there is an "ambulance" service that is made up of normal cars to provide medical transportation.  I will be using one of these for my trip to Poitiers for the IRM (MRI).  Or not - I decided to take the train and save a few Euro.

There are really no pictures that go with this post, so you get random French food.  This is a super tasty tartiflette
Disadvantages of the French Medical System:
  • Daily injections?  Really?  This isn't really a "con" of the system, but I loathe needles and this was a special kind of torture for me.
  • While I understand that there can be issues with people abusing painkillers, pain management is kind of important.  When somebody has torn a ligament, a week's worth of narcotics is not that big of an issue.  Especially when it eventually turns out to be a torn ligament and meniscus.
  • Even though most French people aren't paying for them, I'm not sure what the point is in prescribing a full box of medication instead of just the number prescribed.  I guess the upside is that I can tally up my prior leftovers before filling a prescription, just to be sure I actually need it!  It also saves time at the pharmacy - they just grab the boxes and send you on your way.
  • Again, probably because there is virtually no cost to the individual (and the gov pays either way), you are required to see a doctor if you miss even a single day of work.  Otherwise, you're taking vacation pay for it.  It comes across like your employer doesn't trust you, but actually the government won't reimburse their share without proof you were ill/injured.
  • Due to the house call issue, your doctor really needs to be in your town.  You can't just pick the person in a town 20 minutes away who your friend recommended.
  • There can be a little wait for certain non-emergency procedures.  Like, my MRI can't be done until February 28.  But, I've had to wait in the US for non-emergency MRIs also . . . and there is certainly a long wait for many specialists in the US.  It was over a month both for a dermatologist and a hand surgeon.
And . . . well, that's about it (other than dealing with CPAM initially).  Honestly, the disadvantages are more just nitpicky stuff and I can see why it is rated one of the best healthcare systems in the world.  Due to the low medical costs, I've still paid more in taxes than my medical treatment has cost, so it's still a net win for France, but I'm feeling pretty happy about the medical side of the experience.  There are certain specialties here with a wait due to too few doctors, but that's true in the US also (see above).

Update on my Knee:
For those who are interested, as mentioned above, it appears that I tore the meniscus.  I was allowed to try walking without the splint if I could tolerate the pain, but unfortunately it took less than two days of trying to walk around at work without it before my whole lower leg and foot swelled back up and every step was painful again . . . so I'm back in the splint until after the MRI and treatment is determined.

Of course, I had my own comedy routine on Monday and there really should have been video.  I had asked the doctor if I could drive with the splint off and she said, "if you can?"  I thought this was like the walking and referred to my pain level, so I was determined to tough it out and have my freedom back!  So, I tried to sit in the car and realized that I had to move the seat back.  I was quite proud of myself when I was in, foot on the gas pedal and ready to go . . . except I was so far back that I couldn't fully clutch.  "Ok, so I'll scoot the seat forward a bit. Yep, I can fully clutch now!"  Pushed the clutch in and went to press the brake to start the car.  And learned the doctor literally meant if I was actually physically CAPABLE of driving when I can only bend my knee unaided to the position shown below.
It's enough to sit my foot on the gas, but I tried, and failed, to bend my knee enough to actually raise it off the gas and onto the brake.  I yanked on my pant leg, moved my leg to the brake by hand and went to start the car before the less-stubborn, more-logical part of my brain suggested that perhaps it was not wise to drive, especially a manual, when I'd just had to use my HAND to transfer my foot from the gas to the brake.  This was proven quite true when an attempt to transfer my foot back over unaided resulted in my foot half on both peddles and a bit wedged between them.

So, there will be no driving for me through Feb 28.  Hopefully, there will be good news then and I'll only need a few weeks of physical therapy!  If not, I'll be facing surgery in a foreign country.  The period of time since I injured my knee is the first extended period when I've wanted to return to the US - at home, I know how to take care of myself.  Here, the forms are in French, the instructions are in French, many of the people only speak French.  Naturally, I'm in France, but it adds a level of complication that is really unpleasant when you're already hurt.

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