I lived in the States for 18 years, I live in Europe now. I reside in Madrid but today I had a medical emergency while visiting Paris. It was so well taken care of that I would like to write an unusual post in favor of the French Health System. This is clearly a case and not a statistic but I will try to draw some general conclusions comparing the US and French health care experience.I will limit myself to three key elements of the medical experience, the quality of the medical care, the paperwork and the cost.

The case: I had a 3 cm cut on my chest that urgently required stitches. I was rushed to Hopital St Antoine which is not far from Place des Vosges where we have an apartment (my wife is French and we come frequently to Paris). I was successfully treated and sent home in less than 90 minutes.

During the years I lived in the States I had many occasions to go to hospitals mostly for two reasons: one is that I do a lot of sports and tend to get into silly accidents, the other because of my four kids three were born in the States. When you enter a hospital in America, you are greeted by a mountain of paperwork. The first surprise in France is that there´s no paper needed anywhere, no forms, no signatures. The French have developed what I would call the USERNAME system of medicine. Just like many web sites who just want you as a user and don´t really care about your real identity, the French Emergency Health care system is the same. They would like to know who you are but they do not need to know who you are when you are in a medical emergency. They only need to know that “whoever you are”, you are in danger and they treat you in a rush. As I had to go to the hospital without preparations, I did not have any documentation on me. As I walked in, I worried about this. The first good news was that there were no security guards at St Antoine, no ID was required. Secondly there´s absolutely no paperwork. I had never seen anything like that. You tell them your name, they believe you, you tell them your address, they believe you. They don´t ask you for medical insurance nor for any kind of payment and the whole admission takes at most 45 seconds. Compare this to the situation in America where while you are bleeding you have to hear about insurance, malpractice, payments, you have to fill out forms about allergies and medical history. Again I am one case and not a statistic, but this was indeed my experience after being hit by my opponent with a squash racket in the face and rushing to being admitted at Columbia Presbyterian in NYC (I told you I have silly sports accidents…). Here in Paris they did not care if I lived in France or not, nor that I did not have any documentation on me. They treated my injury with great professionalism and sent me home in less than 90 minutes. They were courteous, they did ask me of course if I had allergies or other usual medical questions but this was all done by the doctor before treating me. It was done as a medical procedure not as a legal requirement. From what I could see the legal system is mainly absent from French medicine. When it was all done it was shocking for me to leave the hospital without having to sign any release forms. The surgeon herself notified the administrative staff that I was done and she released me simply saying that I could go home without seeing anybody. But since I don´t pay taxes in France and everything had gone so well so quickly and free of charge, I felt like thanking everyone at the hospital and I did. They just smiled back probably thinking that I was some weird foreigner. The French see free medicine for all as a right and don´t make a habit of thanking medical care workers, something I feel is wrong as they earn half of what their American counterparts make and their work is mostly vocational.

Now this is my conclusion: America probably has the best doctors in the world, the best medical research in the world and the best hospitals in the world. Once an American medical professional gets to treat you the medical care is great. It is not the treatment itself that is better in France, indeed I am sure that on many occasions it could be worse. But what´s wrong with the American health experience is that it is invaded by a lot of elements that are foreign to medicine. The result is a cost so onerous that the percentage of GDP Americans spend on medicine is much higher than in France but the results are very disappointing. Americans spend the most in the world on medicine but live much shorter lives than most in the developed world. They rank 48th in the world in life expectancy. France is 16th. I am not recommending to any American politician to share my story as praising France seems to be the kiss of death in American politics. Still quietly emulating some of the practices here would make a lot of sense.

Follow Martin Varsavsky on Twitter: twitter.com/martinvars

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Pablo Moreno Galbis on March 24, 2007  · 

Hello Martin,
Personally, my experience with the american doctors is quite bad.

I live in Stanford, and I am fully insured. 3 weeks ago I went to the doctor because I had pain in my lower back. He just asked me a few questions, and then sent me to physical therapy. In there, they concluded without further test, just because I was student, that it was because I did not seat correctly. But they did not give me a single massage. In my second visit, they did the same thing. Finally, I have decided to go to a private massage therapist.

Compare this to my university in Spain, where I saw the doctor, they sent me to the massage therapist inmediately. They gave me a massage, cracked my back, and I was like new 2 days later.

I am really dissapointed about how I have been treated here.

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Richard on March 24, 2007  · 

This reminds me of when I read an English children’s book.

The little girl in the book had to answer questions three times as they “entered a few details into the computer”. This was a book!!!

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Francois Legendre on March 25, 2007  · 

I hope that your health is better

a french guy

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Killy-the-frog on March 25, 2007  · 

French people have a Card (vitale card) with this one you can be reembourse without paperwork (than 900 million claim reimbursement forms per year), and you have to pay only the part of the cost that is not reemburse. If you have a privat insurance to pay this part, you need to pay nothing, and everything is electronically organized.
More info in english: http://www.sesam-vitale.fr/programme/programme_eng.asp

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Fred on March 25, 2007  · 

Il y a aussi la Couverture Mutelle Universelle….

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Cyradoc on March 25, 2007  · 

this medical care system costs us (people who work) an arm and a leg.
You didn’t pay nothing.. “my treat”

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Elliott on March 26, 2007  · 


I was sorry to hear about your wound, but glad that it was successfully treated.

Obviously, one can not generalize from anecdotal events. I preface the following by stating that I have a good, but expensive health insurance plan. A month ago my wife was diagnosed with a detached retina late on a Thursday afternoon. Her ophthalmologist called a retina surgeon (regular ophthalmologists do not do this and there is a local group of 7 surgeons who only do retina surgery) who agreed to wait for us to drive over and see him at 5:30 pm. Obviously, since he is so highly specialized, he does not have an ongoing prior relationship with us or most of his patients. Yet, he, his nurse and office manager stayed past their normal 5 pm closing until 6:30 when they had finalized scheduling her surgery for Friday. All the paid and volunteer staff (admissions, laboratory, nurses, anesthesiologist, assistants, etc.) at the hospital was superb. There was a separate, highly specialized surgical suite only for eye surgery. Yes, there was a great deal of repetitive questioning, but it was always with the concern for the proper treatment of the patient: Do you have any allergies to medications (a color coded plastic bracelet was put on her wrist); my wife is not allowed to have injections on her right arm (another color coded bracelet and a black X on the arm); which eye was being operated on (asked at least 10 times and a black arrow painted on her forehead pointing to her right eye.) The surgeon’s elderly father passed away Saturday morning, but the surgeon’s colleague came into the office Saturday at noon in sandals and shorts to remove the bandages and check the surgery of my wife and 6 other patients. Later Saturday afternoon someone from the hospital called to see how my wife was progressing, to check if she had any questions for the surgeon or nurse and to check on how she was treated by each of the different hospital services she had utilized the day before. This week I finally received notification that I owed $100 in addition to what my insurance company was paying for the hospital and surgeon. I am making a donation to the hospital’s fund for services to indigent patients.

In the US, if you have good insurance or are covered by Medicaid (government social service program) you get all the services you need with minimal additional fees. The problem is for those in the middle with minimal insurance and large additional fees.

One has to be careful in using longevity statistics to judge and compare health care systems. The greatest impact on life expectancy is mortality of 0 to 5 year olds. This is more a result of US social problems, e.g., drugs, illegal immigrants not using medical services, etc., than quality of medical care. According to US retirement tax tables, a 60-year old has a remaining life expectancy of over 25 years.

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Another French Doctor on March 26, 2007  · 

I’m very glad that you were so lucky. St Antoine is my favorite Hospital. I did my studies there.
20 years later, I still working in a hospital and I must say that your waiting was unusualy short. Some patients waite 8 hours and more, before beeing seen in severals hospitals at some particular moments.
What is true, is that in France, hospital doctors doesn’t care about money, and in case of emergency treat you first, and let the administrative work for later.

Anyway, welcome in France.

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Martín Varsavsky on March 26, 2007  · 

Hi Elliott,

we agree. As I said I think that American Health personnel is probably the best in the world. But what is not best in the world is the legalities and paperwork that invade the medical profession.

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Martín Varsavsky on March 26, 2007  · 

Another French Doctor,

Well, my post would have been totally different if I had had to wait 8 hours!!

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gilles amsallem on March 27, 2007  · 

Good to learn that you are better .
Is it a cynic post or real congratulation?
I’m afraid your experience is the prove that health system is not managed .
What would you say if a company neglect to charge its services/products ?
With amazing frauds in the past years. You can understand that French are concerned by total IRRESPONSIBILITY of public sector and health system in particular.
With 35hours and 5 weeks paid vacations , plus frequent strikes for 3M people in public sectors , 3M unemployed jobless … And 3M people ( employees and entrepreneurs ) working sometime more than 50 hours a week , without family life , poor health coverage bad pension …but paying huge taxes to run “like that” a country of 60M ,
Is it sustainable ??
Which society is more equitable? US or France.
At least US society doesn’t pretend to be just and equitable ; it ask everybody to work hard .
One can understand why productive people massively left France, they let the country to people who enjoy the system …But how long it will last ??

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Jean-Michel on March 27, 2007  · 

It feels good to read about your experience with the French Health System. As a French who has lived in other European countries – UK and Spain – and who also does silly sports such as rollerblading, I’ve had plenty of opportunities to compare the health systems and especially emergencies.

My advice to the British journalists, especially those one from the Economist & FT, please take a tour of French Emergencies before writing articles about the decline and out of date social system …

I feel so sad when I read about articles promoting the Walmart model and saying this is the only future. I really hope that the thousands of Brits who go to French hospitals every year because there have “long” waiting lists in the UK will write about their experiences to the hate-generators “tabloids” and their friends.

In Spain, I’d recommend you to come to the 29.5 millions of passengers / year modernista Sodom Barcelona and take a 8 hours tour to an emergency service … or have an appointment to the dentists and pay an “ojo de la cabeza”. As the local governments point out: “Barcelona has the best quality of life in Europe” (maybe for tourists).

More seriously, I also have very bad teethes. When I was living in Paris, as a software engineer, my company was paying fir a very good private insurance. This is normal in France, a vast majority of workers and students benefit from the public system *and* from private insurances. At the end of day, I never had to pay for the 10 000€ dentists bills.

By contrast, in the UK, I had a better salary than Paris but seeing a few 25-something colleagues as “rich” as me but with some teeth missing and thinking to go to Hungary or Poland for the dentists (easy-dentist!!!) made me wonder about the fabulous economy of UK: what’s the definition of wealth? I have the impression that very few companies pay private insurance to their workers in the UK.

In Spain, nobody – normal workers & students – have private insurance and they have to go the public system and make the queue. Unfortunately, public dentists are bad. As I had kept my French private insurance, it was not so much as an issue but I feel sorry for a country whose GNP Growth has been constant since … a lot of time but all this “wealth” has not been shared between Spanish people.

The saddest thing is that most people live in a closed world (brainwashing TV?) and don’t want to know how are things in other countries. Most people in the UK or Spain don’t believe to politics. They think the only future is LESS. Less taxes, less minimum salary, less social security , less kids, less life?

Hopefully, thanks to Martin’s blog and the new Internet medias, e-participative democracy will arise in the XXI st century and economists who have a blind faith in GNP growth, warrants, pension funds and market will be judged by History ….

Sorry about this parenthesis into politics and feel free to reject my comment!

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joanmi on March 27, 2007  · 

Hi all,

Martin started personalizing and most of the comments are going this way but I think the discussion is
between the two healthcare models: public vs. private. In France and Spain the healthcare is a right, and we all
pay the costs as part of our taxes (those that work legally, of course, and pay the social security).

The law says that everybody has right to receive treatment, it doesn’t matter if he is spanish or foreigner, living
in Spain or visiting the country, employed or unemployed. So for that it is the same as in France: you don’t need to
pay anything at the hospital. This is why there is no burocracy: there is no need to invoice! It is tax-paid in advance.
As easy as that.

Anyway, what is the reality about the service? The fact is that for small things (meaning you’re not in serious injury)
you probably have to wait some time (even hours) at emergencies, specially if it is a big hospital.
You will also have to wait, even months or years!, for those surgeries that are not “urgent” (typical queues for hip prosthesis
or eye cataracts).

On the other hand, if you have something serious (your life is in risk, let’s say a leukemia, tumor,
need an organ transplant, etc.), Spain’s healthcare is one of the best in the world (of course you don’t have to wait at

The reason is that Healthcare System needs more resources than allocated, to hire more doctors and improve the services
in the hospitals (more ER rooms, etc.) The priority are serious injuries so if you need a small cure you have chances to wait.

What people use to do is to contract a private insurance and use it for these small cures (I’m saying “small” but of course
when you’re suffering a painful sprain or if you’ve been burned your hand with hot oil, etc., you don’t want to wait 1 hour or
more at ER).

Finally, there is another problem (that is also derived of the lack of investment) which is that some treatments are not covered
by the system, such as the teeth treatments. It is only covered medicines (for the pain) and teeth extraction. If you need
some treatment (even a simple tooth filling) you must paid for it (or pay the private insurance).

Ps. From some time ago we see the same “behaviour” as in France with the british that go there for medical treatment. It is called
“medical” tourism: people coming from other countries, specially northern-african, come to Spain and they go to Emergencies saying
they’ve just had an accident. It is clear on most of the cases that it is not true, but… they receive the treatment. And they
don’t have to pay. Spanish people is paying with their taxes these treatments. Some people surely dislike this (now my opinion) but
I think it is good, I’m proud to help diseased people no matter where they are (and I thank every day to never have had the need of
healthcare system, I’ll like to pay all my life and never use it!). I’m just concerned if it is sustainable, but I think it will
never be a huge percentage.

Greetings from Barcelona…

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mememe on March 30, 2007  · 

Whatever USA, Spain or France… it is good if you compare with China.

Just another personal story from another blog:

In China, If you do not have money you just die, if you have money the hospital try to sell you whatever and find you whatever problem to earn more money, and most of the doctors are incompetent.


PS: I still love France health care system.

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Viktor on March 31, 2007  · 

Emergencies are free in France. Emergency acts are paid directly by the national social security. The national social security’s budget comes mainly from per-employee contributions every company must pay, which are approximately 40% of each employee salary.
PROBLEM No.1: It is difficult for companies to hire people, because contributions are so high.

On the contrary, all other (standard doctors visits) acts are billed to the patient (who then gets reimbursed by his insurance).
PROBLEM No.2: Too many people go to emergency rooms even for basic medical treatments, because emergency rooms are free. Which ultimately costs more money to the government and increases waiting time in emergency rooms.

So the system has downsides and ultimately will be changed.

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ML on April 6, 2007  · 

I’m hapy for you and I’m fear for Franch !
But every contry has an helth system in a direct proportion with their maney
hier we shall change,unfortunatly…

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