Multi-payer health care plans

At a faith in action conference at Iliff School of Theology yesterday, there were a couple people who supported a certain Selvoy Fillerup, MD, who has written a book urging we adopt a health care system more like France's, which is a multi-payer. They enthused that 80 percent of the French buy private health insurance.

Maybe so. More importantly, private insurance covers 12.4 percent of costs in France, only slightly ahead of the 11.1 percent that people pay out-of-pocket.

What's more, the sicker people are — or the poorer people are — the more the government kicks in to pay.

Here's an OECD study from 2004 on private insurance in France. (Click on the pdf for "Private Health Insurance in France," by Thomas C. Buchmueller and Agnes Couffinhal.)

This is the key from that paper:

Unlike in other countries, private insurance in France is not used to jump public sector queues or to obtain access to elite providers. Rather, it provides reimbursement for co-payments required by the public system and coverage for medical goods and services that are poorly covered by the public system, most notably dental and optical care. Considerable research indicates that by reducing (and in some cases eliminating) out-of-pocket costs, private insurance significantly increases medical care utilisation.

Far better than that study, the American Journal of Public Health has a great article from 2003 on how the French system works. (Click on full text for the pdf.) The editors note that "Lessons for the United States include the importance of government’s role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market."

Another, harder lesson: "In France the commitment to universal coverage is accepted by the principal political parties and justified on grounds of solidarity--the notion that there should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk."