Healthcare costs

[sueyh]

Is this the Connexion scare-mongering?

http://www.connexionfrance.com/Healthcare-UFC-Que-Choisir-mutuelles-13035-view-article.html

SueyH

[cooperlola]

 

Judge for yourselves

I don't know if this has already been posted (?) but I'm not sure it's really news.  Clearly the health services here (financing of) are in the poo and somebody has to pay. 

[NormanH]

As you know I am not a big fan of the Connection, but I think that here they are reporting a trend that is well-established. The report they are quoting comes from Que Choisir is a consumers' organisation a bit like Which.

More and more costs are being loaded onto Mutuelles, and these are in business, not there to provide free care, so they will obviously seek to pass on costs.

For the sort of cover I now need, admittedly with a poor history, I am looking at near €140 a month to be sure of say 3 months full cover in a single room if I have to go back into a Nursing home.

That is near the top of the range, but cheaper options often have nasty 'small-print' clauses leaving you with no support just when it is needed.

[idun]

No scare mongering at all. The Secu has been in a trou noir for years, they never manage to sort it and it just keeps getting worse. Friends have been telling me about the changes over the last couple of years and I know that if we had stayed we would have been paying quite a lot more.

[NormanH]

[quote user="cooperlola"]

 

Judge for yourselves

I don't know if this has already been posted (?) but I'm not sure it's really news.  Clearly the health services here (financing of) are in the poo and somebody has to pay. 

[/quote]

One of the major problems is that the suppliers (Pharmaceutical companies, transport providers, equipment manufacturers etc) make a huge rake-off from hiked prices, and there doesn't seem to be anybody with a grip on this monitoring the Budget.

Just compare drug or equipment prices on-line between France and the UK.

The consequence is that patients are virtually blamed for consuming too much care, when in fact it is a huge business milking off the State that is largely responsible.

[idun]

I would imagine that in France as in the UK people get their medication and do not take it, or take it all. We had a cupboard full as we were leaving France. Some I took to the pharmacie, the rest came with us, some probably still never used and out of date now.

The other serious problem was those ordenance the toubibs give out, at least three things on each of them. I would often refuse all the other stuff they were trying to give me and would just have one thing on mine.

Used to amaze me in my french village to see so many people leaving the pharmacie with carriers, sometimes more than one, full of medecines.

I have read that people should lead healthier lives to keep illness at bay. Well quelle belle exemple Carla is, cannot wait to give birth so she can hit the fags and booze again....... healthy living nez pah!

 

 

[AnOther]

[quote user="idun"]Well quelle belle exemple Carla is, cannot wait to give birth so she can hit the fags and booze again....... [/quote]

Married to Sarko what woman wouldn't [:D][:D][:D]

I'd always thought that my current corporate health care plan (AxA), which has an option to continue with privately after I retire, would be too expensive - with the way things are going maybe I'll be proved wrong !

[Rabbie]

No wonder we have such a resistance problem nowadays with antibiotics if people are so irresponsible as not to finish the course they have been prescribed. 

[5-element]

A big problem is the chemist giving far more pills than the amount prescribed by the doctor. So often, there is half a box left once the course is finished, and no use for them. Taking them back does very little good (doesn't benefit anyone, since the Medicare scheme (to send them to parts of the world with little healthcare) was scrapped and all returned medication is destroyed). Of course "le trou de la Sécu" could not be sorted with just giving each patient exactly the amount of medication prescribed, but it could be a start.

It seems criminal to me to destroy life-saving medication, when so many people, in so many places in the world, die through lack of them and of healthcare (even though this is a separate issue from our own healthcare costs).

[pachapapa]

With current deficits and forecasted deficits it seems to be more of a lottery than a self financing insurance scheme.

The UMP should be congratulated on their courage in grasping the deficit nettle; as in effect the obvious lack of self financing is an unfair taxation burden on young people who are already struggling.

[mint]

I'm probably sticking my neck out here by saying that the French health system is unwieldy to administer and many costs are integral to a system that is part private and part public.

You only need to think of all the "administration" with service providers (medical bods, ancillary bods, pharmacists, etc etc) and mutuelles and CPAMs all being paid in different proportions by the users and the state.  Just the thought of all those communications, even if they are now electronised, is utterly crazy.

Not only that, I think people get too much treatment here, because doctors, just to take one example, only get paid when they see a patient, therefore they get the patients to come back even when unnecessary.

I'll just take myself to demonstrate the prodigal use of resources.  As a long-term asthmatic, my drugs haven't changed in over 15 years.  Back in the UK, I don't "waste" doctor time, I go to an Asthmatic Clinic run by a very experienced nurse (cheaper therefore for the state than a doctor)  She tested my lung function and, if all was well, my prescription was renewed a year at a time.  I was always free to go back if I had a chest infection or just wanted advice to manage my own condition.  Once a year, I saw the doctor who then reviewed my drugs.

Here, in France, I have to go to the doctors' every 3 months because that's the maximum period I can persuade them to give me repeat prescriptions for.  They do nothing else than write out my prescription when they see me so it's not as though I am having my condition monitored.  The one and only time I had my lung function tested was when I specifically asked to see a Specialist before my walk in Spain as I wanted to ensure I was in the best condition to finish the walk.

So many unnecessary visits to the doctor!  And that is just one small example of waste.  You should see the amount of Doliprane they prescribed for OH when he busted his knee.  We worked out that it was something like 20 times more than he needed.  We did manage to get the pharmacist not to give us a whole carrier bag of painkillers to take home!  Blimey, we could have arranged a suicide pact for everybody on our road and still had pills to spare![+o(] 

 

[NormanH]

I agree with you sweet.

I said something like this on another thread not long ago, about blood pressure I think.

[AnOther]

Another example of profligate waste.

A friend of mine here near where I live had to go to Toulouse for a relatively minor operation although it meant an overnight stay.

He has a car, more than one in fact, is not short of money, plus both he and his wife are perfectly capable of driving to Toulouse and back but because the system allows it, and the doctor authorised it, he booked a local taxi to take him there, the driver then came all the way back to the village and went back to Toulouse the next day to collect him, total bill around €800 !

Thats not a criticism of my friend but of a system which permits such lunacy. I have no problem with the principal because for many elderly or infirm it may be the only way to get them to the treatment they need but for the able bodied and capable it is indefensible and I think such facilities should better controlled and allocated.

[Rabbie]

SW17, I think you will find that things have changed in the NHS now. We have to attend the doctor's surgery every 3 months to get our repeat prescriptions renewed. so it doesn't seem like there's a lot of difference between the two countries. Of course because visits to doctors in the NHS are free there is always long queues at the surgery. Waits of over 30 minutes are not uncommon. Bureaucracy and efficiency seem to be mutually exclusive.

[Gardengirl]

[quote user="AnOther"]Another example of profligate waste.

A friend of mine here near where I live had to go to Toulouse for a relatively minor operation although it meant an overnight stay.

He has a car, more than one in fact, is not short of money, plus both he and his wife are perfectly capable of driving to Toulouse and back but because the system allows it, and the doctor authorised it, he booked a local taxi to take him there, the driver then came all the way back to the village and went back to Toulouse the next day to collect him, total bill around €800 !

Thats not a criticism of my friend but of a system which permits such lunacy. I have no problem with the principal because for many elderly or infirm it may be the only way to get them to the treatment they need but for the able bodied and capable it is indefensible and I think such facilities should better controlled and allocated.



[/quote]

Just as many friends tell it; taxis to Nimes hospital at very regular intervals when they are all perfectly willing and able to drive themselves or husband/wife. One neighbour doesn't drive, buses aren't at useful intervals, so the taxi is a godsend, but usually just more in the pockets of the taxi companies.

[idun]

Rabbie, our dr's surgeries in the UK have systems in place where we can order on line and even order via our local pharmacies. My husband who needs certain medications only sees his dr or the nurse practitioner once a year. How can this be so different for you?

[sueyh]

Surely it is better to visit the dr for the prescription three monthly, at least then you have the basic checks done.

Suey

[idun]

I suppose all this talk of people using the system and taking taxis when they don't need them is down to being decent honorable human beings or not.  Adults know that these systems are in place to help those in real difficulty,no car, not having someone to drive them, too ill to drive themselves when no other options are available and no easy access to public transport.........and not just for anyone, it is simple common sense.

I know my french friends would say something to anyone they knew of who was doing such a thing, and as GP's in the villages and small towns tend to 'know' their patients, then they should have more sense too.

I don't have much time for people who sap the health systems anywhere when they shouldn't.

 

[idun]

[quote user="sueyh"]Surely it is better to visit the dr for the prescription three monthly, at least then you have the basic checks done. Suey[/quote]

 

I think that we always have seen the dr regularly when initially treated and prescribed, but once everything is in place and the prescription suits, and the patient is feeling fine, what is the point of seeing the dr more often than once a year?

[Rabbie]

[quote user="idun"]Rabbie, our dr's surgeries in the UK have systems in place where we can order on line and even order via our local pharmacies. My husband who needs certain medications only sees his dr or the nurse practitioner once a year. How can this be so different for you?[/quote]Obviously different Health Authorities in the UK have different ways of  working. I wouldn't mind the visits if the doctors actually did any tests or whatever. It just seems to be a case of turning up and then they authorise the repeat subscription. It could be done just as well over the telephone.

[idun]

I've pm'd you

[Frecossais]

Rabbie, our surgery too has stopped renewing prescriptions by phone, we have to go to the surgery and ask the receptionist to ask the doctor to write a new one. Mine is collected by a local chemist and I collect straight from them.

Two things are rather annoying though: prescriptions are now only 2 months worth, which can be tricky if we stay at our French house for longer, and some drug companies seem to think that a months supply is 56 tablets. No allowance made for 30 and 31 day months. Ggggrrrrrr

[idun]

I know that they don't usually take them over the phone in the UK now, but I would imagine that all do them on line.

I hate the way they do prescriptions in the UK, prefer the french system as it was for us at least. Although I am told that one can have it as per the french system.

 

[Clarkkent]

[quote user="Rabbie"]SW17, I think you will find that things have changed in the NHS now. We have to attend the doctor's surgery every 3 months to get our repeat prescriptions renewed. so it doesn't seem like there's a lot of difference between the two countries. Of course because visits to doctors in the NHS are free there is always long queues at the surgery. Waits of over 30 minutes are not uncommon. Bureaucracy and efficiency seem to be mutually exclusive.[/quote]

I suppose everyone has his or her own experience of the NHS.

I make an appointment to see my GP and he usually runs on time, I have never had to wait more than about five minutes beyond my appointment time. If I wish to see him that day or within a specified number of days it can always be arranged. If he is not available then one of his partners will be.

I order repeat prescriptions on line and, because I live in the country, can pick the completed prescription from the dispensary at the surgery or have it delivered to my home. I believe that a decision was made some years ago that prescriptions should be limited to supplies for 28 days - presumably to minimise waste, but also, I seem to recall, to minimise the opportunity for overdose (which is also why there are restrictions on the quantity of aspirin and paracetamol one can buy in supermarkets). I see my GP once a year to review my prescriptions.

Should I require more than 28 days supply of any medication I simply place two orders on line.

The asthma clinic is run by a nurse, vaccinations for foreign travel are given by a nurse.

[Daft Doctor]

Hi, in the UK each surgery can make their own arrangements for repeat prescriptions.  Being 100% computerised, in our practice all medication needs authorising every 12 months.  We do this efficiently by telephone consultation, asking and checking that any routine chronic disease monitoring, tests, etc have been done.  There really is no reason whatsoevever (in the UK or otherwise) why someone on regular medication needs to see a Dr every 3 months.  If a UK practice is doing this, its badly organised and not best serving the needs of the patients.  In France, quite frankly it is likely to be to maintain numbers coming through the door and, therefore income.  That isn't to criticise French GPs, but its a reality of a system in which payment is made per visit.  

We give 56 day prescriptions as routine.  It strikes the balance between avoiding waste (e.g. patient has treatment changed by hospital - 3 months medication goes down the pan),  preventing stockpiles of medication (I have literally been in homes where cupboards have been stuffed full to overflowing of expensive drugs which the patient isn't taking but still orders) but reducing inconvenience for patients.  The cost isn't an issue for most patients as only 1 in 5 actually pays prescription charges, but I think 56 days is fair.  Btw, most drugs are packaged now in 28's, and splitting packs by giving 30 days or 60 days worth instead increases cost to the NHS.

What doesn't seem to happen so much out of hospital in France is the team approach we adopt in the UK to chronic disease monitoring and the use of computer systems to record clinical information, prescribing, test results, etc.  We use nurses very efficiently for this, leaving poor souls like me to deal with problems which arise, which after all is what I was trained for.  Perhaps if the French are feeling the pinch, they could do worse than look at the way we do SOME things in the NHS.  As an aside, I was pleased to see that GPs remain by far the most trusted profession in the UK with over 90% of people saying they trusted their family Dr.  Also, we are the most appreciated group in the NHS, with our score in that context increasing from 76% to 80% between 1999 and 2009.  The Daily Mail may love to give us a bashing, but actually overall we don't do a bad job, and do huge amounts to keep NHS spending under control.  I know that French GPs will do just as good a clinical job as we in the UK, but I'm not so sure everything is done to harness costs.  I read recently that on average a French person will leave their GPs surgery with a prescription for an average of 3 items.  That is staggering, with huge cost impications, but when patients are paying 22 euros a pop to see their GP, perhaps 'I'm pleased to say Mr/Mme X that your symptoms will settle in a few days without any treatment' just doesn't wash!