France counts cost of health reform

By Allan Little BBC correspondent, Paris

The French have a history of fiercely defending their health service

Doctors, nurses and other health professionals have taken to the streets of Paris to protest against government plans to cut back on a health service which has a projected overspend this year of eight billion pounds.

The other day, an American friend, recently returned to live again in Paris, e-mailed from her sick bed.

"This is why I like France," she wrote. "I have bronchitis and the doctor has just been to see me in my own home.

"He stayed long enough to examine me thoroughly and carefully, prescribe some drugs, drink two vodkas, eat pistachios by the fistful, and then chat about his days as a young doctor on an ashram in India. And all paid for by the state!"

Our health system is being sacrificed to political dogma A&E specialist

The abundance and generosity of its health service has turned France into a nation of hypochondriacs.

It consumes far more drugs than any other nation in Europe, and they are almost always the expensive patented kind rather than the cheaper generic alternatives.

French pharmacists have never had it so good. And now they fear their government is going to ruin it.

On Thursday, the government is publishing a report called Hospital 2007.

"You know what that is about do you not?" one well known accident and emergency specialist said.

"Anything marked 2007 is about the next presidential election and Jacques Chirac. Our health system is being sacrificed to political dogma."

Clinical waste?

Patients often choose to visit several specialists

In France you can go straight to a specialist without being referred to a general practitioner first.

If the specialist conducts expensive tests and then says there is nothing wrong with you that a good night's sleep will not cure, you can go to another specialist who will conduct the same tests a second time without knowing that you have already had them.

People come to ask me to carry out tests and they have already had the same tests somewhere else Parisian GP

It is not unusual for people to go for a third, fourth or fifth opinion until they find a specialist who will give them some pills.

I visited the surgery of a GP on the outskirts of Paris. His accommodation was far from lavish. There was no visible waste.

"But," he said, "I see this every day. People come to ask me to carry out tests and they have already had the same tests somewhere else."

How many of his patients sometimes behave in this way? Eighty per cent maybe.

The GPs have proposed the introduction of a single internet dossier for each patient, so that the GP can call it up and see whether the patient has already been treated. But it will take years to introduce, he said, and the patients will not like it.

Wine with dinner

It will be a brave politician in France that dares to stand between the French patient and his right to find a doctor who will tell him what he wants to hear, before sending him home with the drugs he thinks he needs.

It is the World Health Organisation (WHO) that ranks the French system as the best in the world.

For every pound that is spent on the NHS in Britain, France spends something like £1.30, for a population roughly the same.

The treatment itself is not that different to what you would get eventually in Britain, but they just seem to be able to get on with it here British man undergoing French treatment

France provides nine hospital beds for every 1000 people, Britain five.

Waiting lists are not a national obsession in France because they hardly exist.

A British man who came to have a hip operation here was astonished to find that the package he was given included a private room with a second bed for his wife, two weeks post-op physiotherapy, and - of course - wine with lunch and dinner.

"The treatment itself is not that different to what you would get eventually in Britain," he said. "But they just seem to be able to get on with it here. Everyone just mucks in to get the thing done."

Health Minister Jean-Francois Mattei has a battle on his hands

But there is a problem. Eight billion pounds worth of problem. That is this year's projected overspend on health alone.

The reason is clear and will have to be confronted in the end. It is demographic.

People are living longer, calling on health resources more frequently, and for longer, and all the while a smaller and smaller proportion of the actual population is working and paying taxes to fund it.

The last time a French government tried to confront this reality - in 1995 - and introduce structural reforms, there was a popular explosion.

The trade unions - with the backing of the public - brought the country to a halt and ended the presidential ambitions of the then Prime Minister Alain Juppe, who remains unpopular to this day.

The French look across the Atlantic with horror at the US model. They are almost as appalled by the British example. But the government knows the arithmetic is unanswerable. Sooner or later the sums will have to add up again.

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From Our Own Correspondent was broadcast on Thursday, 22 January, 2003 at 1100 GMT on BBC Radio 4. Please check the programme schedules for World Service transmission times.