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This is one for ablf


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Andy, you make a good point...up to a point.

In France, our "village" (for village it is, although much bigger than many) is growing exponentially. It used to have a population of about 1500, but I suspect it's much more now, as new people seem to be moving in all the time. Mind you, we are only about 15 minutes from a largish town in one direction, and 25 minutes from another.

However, the village isn't on a main road...you have to want to go there or have a reason to do so. Thus, the local commences serve the villagers and no-one else. I've seen in the village magazine the scale of the subsidies given to the businesses owned by the commune...the tabac, boulangerie and bar/hotel...which are pretty substantial. There's also a Co-op which moved into bigger, swnakier premises built by the commune a number of years back, and a brand new pharmacie replacing the older, perfectly serviceable one for which, apparently, the rent was getting a bit high.

Twice a week, a pizza van used to come. People would queue. Then another pizza van came on two different days. And now an interiors company went bust and a pizzeria has opened. So I'm guessing I live in the official pizza capital of the Charente Maritime.

On the one hand, it seems to be the British, Dutch and German immigrants who keep the bar, tabac and (to a lesser extent) pharmacie going. Plenty of French locals used the first pizza van, but I'm guessing that with two vans plus a restaurant the desire for daily pizza might be waning. The restaurant has staggered its days off with the restaurant in the village centre in an effort not to directly compete. I've only been there once and it was empty apart from non-French.

Yes, there's a lot to be said for the ageing Brits (and other nationalities) who live in the village, because I see first-hand that they're keeping lots of local businesses afloat. I was, however, aghast to learn that a friend who had an operation was ambulanced to Bordeaux, operated on, transferred back to the local hospital, then ambulanced BACK to Bordeaux...to have his stitches removed. And then returned to the hospital from whence he had come. Friends regale me with tales of their wonderful treatment in France (when they're not telling me that they've changed doctors because they have had misdiagnosed cancer from the local one, or that, as the surgery is a doctor short, they have to wait days for an appointment and hours once they arrive for it.)

Many of my friends in the village are now well into their 70's and I would be hard pressed to make up an entire, fully operating human being from the sum of their working body parts. They're keeping the doctor, hospital and local nurses, physios etc., on speed dial and they're all on first name terms with all of them.

So, yes, they're helping to stop the local economy from flatlining (in terms of using the shops, etc., but they're definitely causing a lot of extra strain on medical resources in the area. They think they're getting wonderful service and treatment because they see quantity, not quality, as an indication. And they're a drain on a scarce and costly resource.

I'm not for one minute suggesting that they aren't entitled to receive treatment, just that their meagre contribution to the local economy is certainly eclipsed by the cost (to whichever government foots the bill) of their medical care. And if that's the UK eventually, happy days. But it's not just the money that's important, it's the time and resources being taken up by these people which is, I am pretty sure, disproportionately high compared to the rest of the village's population.

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[quote user="andyh4"] ..................... the mobility that railways brought to the population as a whole contributed greatly to the end of the village idiot.  ................[/quote]

Obviously the railways reached some areas much later than others..........

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NoMoss

And in our case the railway never got within 10km - and it shows. 3 surnames predominate - in local politics, in local clubs and societies and in names on the war memorial One of those I believe were late comers having arrived from the Sardinian empire when Savoie was ceded to France in the 19th Century.

Betty

what you describe sounds like progress - whether it is good progress or bad progress only time will tell. If the population is expanding as you suggest then it suggests one of two things:

A lot of new housing is being built to accommodate these extra people

You had a lot of unused property in the past that is now being brought back into productive use.

You talk of older people being a burden on resources. Is that your prejudice or have you proof that resources for locals are being denied them because the outsiders are taking them?

Extra people certainly mean more resources are needed, but that can work both ways. It can put a strain on resources and it can mean that resources that might have been put under threat are now fully utilised and threats of closure are removed.

Compare and contrast:

Back in the UK we were 45 minutes from a major hospital. The next village had a cottage hospital. It was deemed inefficient and under utilised and consequently closed. Then they built a new housing estate in our village but too late. The first medical resource beyond the GP was 45 minutes away.

Here in France as a wrote earlier our local hospital has been/is being expanded to meet the local needs. For major issues however we are still 50 minutes away from a major hospital. the difference being that the local hospital can make an assessment about whether you need to make that journey.

In all of this it is also worth remembering when we are being critical of individuals who are going to consume resource, that that, in all probability, be the case whether they are in deepest France or back in their home country or home city. The resource would likely be consumed anyway with perhaps the exception of transportation to hospital, where, because of the lower population density of France, distances are likely to be longer. But use of doctors, nurses, technical resources and medications would likely be the same. If referring to ex-UK residents then (given the recent news articles and posts here) it might be advantageous that these people are in France and not taking up more NHS resource directly.

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Andy...you've just made my morning, if not my entire week. "You talk of older people being a burden on resources. Is that your prejudice.......?"

Well, given my age (21, obviously) I'm in no position to be prejudiced against older people.....

And resources? Well, I don't think the resource would be consume irrespective of country. Simply because if these people were in the UK they wouldn't get someone coming round to their house daily to change a dressing, or administer an injection or whatever. That's human resource that could be deployed elsewhere. They wouldn't be sent to some re-education centre for 3 or 4 weeks after surgery or illness, they'd be sent home. That's resource that's being taken up.

I'm not convinced, entirely, that increased population and improved resources to hand in hand. I see a lot of under-utilised resources - our spiffy new all-singing, all-dancing gendarmerie (closed for all but two half-days per week) is a case in point.

My point is/was that resources are being provided (or subsidised) on behalf of the indigenous population, but were it not for the foreigners,they'd be grossly under-utilised ( and in some cases, they are anyway) whereas services such as medical care are under strain.
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Andy...you've just made my morning, if not my entire week. "You talk of older people being a burden on resources. Is that your prejudice.......?"

Well, given my age (21, obviously) I'm in no position to be prejudiced against older people.....

And resources? Well, I don't think the resource would be consume irrespective of country. Simply because if these people were in the UK they wouldn't get someone coming round to their house daily to change a dressing, or administer an injection or whatever. That's human resource that could be deployed elsewhere. They wouldn't be sent to some re-education centre for 3 or 4 weeks after surgery or illness, they'd be sent home. That's resource that's being taken up.

I'm not convinced, entirely, that increased population and improved resources to hand in hand. I see a lot of under-utilised resources - our spiffy new all-singing, all-dancing gendarmerie (closed for all but two half-days per week) is a case in point.

My point is/was that resources are being provided (or subsidised) on behalf of the indigenous population, but were it not for the foreigners,they'd be grossly under-utilised ( and in some cases, they are anyway) whereas services such as medical care are under strain.
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Betty

you look at this (not unsurprisingly) from a very Anglo centric viewpoint driven by accountants whose sole purpose is to look at every problem from the start point of what is this going to cost me/my business/my organisation and not from a viewpoint of what is this going to cost society.

Sorry if this is beginning to sound a bit ALBF, but there are other ways of doing things and just maybe they are better.

So to take your trips to hospital to have surgery and then return later for the surgeon to remove them (OH has had a similar experience); in the UK surgeons are in such a treadmill that it is becoming a "15 minutes, you're done, next please." exercise. The only time a surgeon is likely to get follow up on a day surgery is when it goes wrong and the patient has to come back. Perhaps sometimes it is better if the surgeon gets to see his patient again (to remove the stitches ostensibly) and check that all is really OK (rather than the patient saying everything is fine). OH's experience was that her stitches were taken out by the local nurse, who, through lack of experience of the specifics, missed a couple of things when the stitches were removed. She did pick the problem up 3 visits later (a week) but by then a return to the surgeon was absolutely necessary and after the subsequent operations he made sure that he removed the stitches.

Regarding the nurse doing a round a visiting patients (and they don't visit all by any means), is it better that 20 patients each make a 5km journey to the nurse (total 200km travel overall) or that the nurse does a 100km round and takes them all in? And putting an accountant's hat on, in a country with 10% unemployment, how much does it matter if the nurses' time is not used optimally if the overall efficiency for the community as a whole is improved?

You say again that medical care is under strain in France and while finances are indeed under pressure, in terms of the practitioners I see much less evidence of strain than in the UK - there are some exceptions (for example ophthalmics) but by and large getting appointments and getting them quickly is the order of the day - at least round here.
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And again, overall I agree, and I take your points. However, the French health service costs. It has a massive deficit, just like the NHS, and France, I believe, still has one of the highest, if not the highest consumptions of drugs in both unit and value terms in the world. On some levels, that's costing society.

People in France go to the doctor's expecting to come out with a prescription for a plethora of drugs. If they don't, they feel somehow cheated. That's creating a perception that quantity equals quality.

I'm not specifically looking at the finances, (God knows, if you knew me you'd appreciate that with my mathematical aptitude that's the last thing I'd be analysing) although they are important. However, the financial cost has a direct impact on society, surely...if it's society that's footing the bill. And let's not lose sight of the extent to which society IS footing the bill in France. Healthcare is good, or perceived to be so, because people are paying through their salary deductions and top-up insurance for the service.

Individual practitioners may well not be under strain in the same way that UK GP's or hospital staff are. I just wonder how "expats" can be considered to be "contributing to the economy" of an area if they're largely retirees causing an increasing burden on healthcare and whilst their main contribution to the economy is spending a few quid occasionally in the local pizzeria and buying a baguette or three. They're not contributing a whole lot to society in their chosen place of residence. Most of their contribution has been made to the society from whence they originated.

I'm not waging an us-vs them war here. I see both the French and UK health systems as deeply flawed for very different reasons. I do tire of hearing from French-resident friends of "how marvellous" the treatment they receive in France is, compared to the UK..especially those who then conveniently overlook the horror stories they've told me about that very French system a few months before. The majority do seem to measure that marvellous treatment by the number and variety of drugs they've been prescribed, or the number of home visits, hospital stays and prescribed treatments by physios they've had. Theyre using resources. OK, they're paying for it, but they're chucking a few quid into a fund that's largely been financed by people who've been paying for it all their lives.

Yet, comparing apples with apples, my son and a young French friend both sustained exactly the same injury of the ACL within months of one another. The French lad had a major operation, was in plaster and on crutches for three months, and had thrice-weekly physio for a month. My son had weekly physio for six weeks with follow-up exercises to do at home on his own, then went back to see the surgeon who examined him and said that there was no need for an operation thanks to the assiduity with which the boy had done his physio, and they're both healed. Husband had a similar conversation with two French friends re. an Achilles injury. The two French blokes (father and son) both proudly showed off their twelve-inch operation scars. OH had no operation, much physio and rehab, and the results all round are the same. And as an aside, he was seen as a private patient in the UK.

We've all got our stories of why system A has served us better than system B....
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Huge bias using examples that prove nothing. A main difference between the French and British systems is that the the French preempt problems and use preventative medicine while in most cases the British wait until the problem shows and deals with it as soon as possible afterwards. The economics of the two systems cannot be compared by a lay person with only few details at their disposal. Different philosophies and I know which one I prefer now, even if it did take a bit of getting used to. A bit like my local brico closing at lunchtime, an excuse to moan but actually not really a bad thing at all. Different not wrong.
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I think betty is quite correct.

The health system in France is run as a business. I personally don't have much confidence in it to the point that I avoid going to doctors as much as I can. Whilst I can get a doctors appointment the same day / next day I wait to the problem is serious enough to warrant an appointment. Most people will go when they don't really need to just because the service is available. Is that waste ?

The emergency services and emergency care is superb mind you. Outside that, then it is a lottery depending on the doctor or specialist that you see. Some are great and some are useless. I have to admit, our rural doctor was brilliant. I do think rural doctors are better than city doctors.

Doctors do unnecessarily prescribe things. They always tend to refer you to a specialist (except rural doctors) rather than tackle the problem themselves. Then you wait weeks or months for the appointment and then nothing gets solved.

Eye care is a disaster in France outside of Paris.

So I think if the UK got on top of emergency care and social care they would have a much better system.
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[quote user="You can call me Betty"]I just wonder how "expats" can be considered to be "contributing to the economy" of an area if they're largely retirees causing an increasing burden on healthcare and whilst their main contribution to the economy is spending a few quid occasionally in the local pizzeria and buying a baguette or three. They're not contributing a whole lot to society in their chosen place of residence.[/quote]

Hmm, are you not confusing the poolside, wine swigging part-time idlers with full-time involved retired residentsI? I assume the statement was  a 'blague' for the benefit of we immigrants. I don't know where you hang your hat in France or what sort of company you keep but the immigrants I know and associate with have, over the years, pumped millions in to the French economy by way of taxation, investment and purchasing. As we are legally resident in France we are entitled to expect and receive the same standard of health care as the indigenous population and let those in charge ie. politicians sort out the finances of the present system.

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Betty

I was not intending my posts to be a p155ing contest to prove one system is better than another, but to point out that there may be good reasons for the differences. Part of those differences may indeed be expectations and I personally agree about the dishing out of tablets plus tablets to counteract the negative effects of the first set of tablets, plus a third set of tablets to minimise the after effects of the second set, plus some paracetamol - which might have done the job in the first place, but which you cannot just buy for 16p per pack at the Supermarket as you can in the UK. [There is a debate there to be had as well. I personally think the UK is too lax in what can be obtained over the counter.]

To reinforce Cajal's post, UK pensioners are not a burden on the French system (by and large) the costs are paid for by the UK (assuming that is the state who issues their S1. Their use of the system is not (as far as I am aware) denying or delaying the treatment of French patients needing the same services.

What UK pensioners may well be is a burden on the UK system, for which they pay nothing, as do UK based pensioners. If there is a problem with the systems it is possibly that someone like me (and from your posts perhaps you) who has a good retirement income does not have to contribute to healthcare beyond my voluntary choice to take out mutuelle cover - just like any Frenchman or woman. That I pay that is entirely my choice, that I might be in a position where I have to pay that by choosing France as my place of residence is again my choice. I could have stayed in Germany and contributed 13% income for 100% cover. I could have returned to the UK, paid nothing and still received 100% cover.

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If I may chip in to this debate:-

'' To reinforce Cajal's post, UK pensioners are not a burden on the French system (by and large) the costs are paid for by the UK (assuming that is the state who issues their S1. Their use of the system is not (as far as I am aware) denying or delaying the treatment of French patients needing the same services. ''

My take on this is, in any area with a lot of UK retirees could the fact that the local medical services receive payment from the UK be a major contributory factor to those local medical services remaining viable. ie, without the UK payments there would be a case for closure of hospitals / clinics etc which would then adversely affect the local indigenous population.
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As a poolside part-time idler (no wine swigging involved, I can't stand the stuff) I may be confusing the people I know with a wider, much more affluent population who work in France and have made social contributions, but I would struggle to imagine that the latter form a majority.

I am surprised that MY "huge bias with examples that prove nothing" is somehow more worthy of contempt than any "huge bias with examples that prove nothing " from someone sitting on the other side of the fence, but I'm happy to take that on the chin. As I said, we've ALL got examples and in general, nothing is what they do prove, as they can only, generally speaking, be based on personal experience.

Read through my other posts and you might notice that my "bias" has often extended to saying that I'm no particular fan of the NHS, but I remain unconvinced that the French health service is a better model.

I leave you with the thought that many, most, a large number of British pensioners living in France are quick to become righteously indignant if the mere threat of some reduction or withdrawal of their "rights" as pensioners is made. Winter fuel allowance, anyone? The principal argument being that "we've paid for this throughout our working lives and should be entitled to it". Or, if you live in the UK, there's the same group complaining in many areas that "you can't get a GP appointment for weeks, but all these immigrants just breeze in and get seen immediately".

Let's see if/when/whether the rosy-cheeked French peasants (a scary number of whom seemed to be on-side with the fragrant Marine) are less likely to start mumbling about "immigrants" in the coming years, as an ageing foreign population places increasing strain on their resources. And whether the current preferential treatment in the form of reciprocal healthcare agreements will survive Brexit unscathed.

But hey, I love the blinkered approach. Of course, if it wasn't for all these Brit immigrants, there would probably be massive redundancy in the French Health service. I mean, we're practically doing them a favour by moving to France to be ill.. As if.
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Betty wrote :

" I mean, we're practically doing them a favour by moving to France to be ill"

Have you not read the news !!! They have just opened a new hospital in Calais for the British. Seriously. It is there, empty and waiting for you. For hip replacements and...ummm...... hip replacements and liver disease.

They missed trick though, I would have opened a hospital in Eymet. Or perhaps Sarlet. Or anywhere in SW France.

Or would a psychiatric hospital be better in these places ?

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