US and French Health Care Systems: Two Examples
Posted by Phoenix Woman on December 23, 2007
Over at DailyKos, nyceve tried last week to get CIGNA to OK a liver transplant for a seventeen-year-old girl, Nataline Sarkisyan; the transplant happened, but the girl died anyway, likely because (as a transplant surgeon who wished to remain anonymous stated) the surgery had been deliberately delayed too long:
Insurers always qualify their denial letters with a sentence to the affect that the doctors must provide whatever care is necessary and that the payment is a separate issue. Insurers never deny CARE only the authorization for payment. To stall the actual delivery of care, insurers hold out an insincere promise to authorize payment if only the doctor provides more information. This leads the doctor on indefinitely, while insurers never says absolutely ‘No’ until the patient gives up or dies.
I agonize every day whether to wait one more day for the promised approval, or go ahead with the surgery and potentially damn the patient, their family, and the institution to assuming the insurer’s responsibilities and financial consequences. If I do go ahead without approval, as I have on many occasions, the administrators in my hospital call me in to explain why so many of my patient’s insurers are not paying and why am I performing surgery not approved by the insurer? No one rescues the patient and the family who face huge bills and bankruptcy.
Nataline was killed weeks ago, once the insurer decided to stall.
It didn’t have to be this way, as Jerome a Paris, a French Kossack whose son had a life-threatening brain tumor, can attest:
He was first diagnosed by our pediatrician, a private sector doctor, who sent us to the (public) specialised pediatric hospital in Paris for additional exams. We did a scan and a MRI the same day, and that brought the diagnosis we know. He was hospitalised the same day, with surgery immediately scheduled for two days later. At that point, we only had to provide our social security number.
Surgery – an act that the doctor that performed it (one of the world’s top specialists in his field) told us he would not have done it five years before – actually took place the next week, because emergency cases came up in the meantime. After a few days at the hospital, we went home. At that point, we had spent no money, and done little more than filling up a simple form with name and social security number.
Meetings with the doctor in charge of his long term treatment, and with a specialised re-education hospital, were immediately set up, and chemiotherapy and physical therapy were scheduled for the next full year.
Physical therapy included a few hours each day in a specialised hospital, with a varied team of specialists (kinesitherapy, ergotherapy, phychologist, orthophonist) and, had we needed it, schooling. As we lived not too far away, we tried to keep our son at his pre-school for half the day, and at the hospital the other half. Again, apart from filling up a few forms, we had nothing to do.
My wife pretty much stopped working to take my son to the hospital every day (either for reeducation or treatment) – and was allocated a stipend by the government as caregiver, for a full year (equal to just under the minimum wage). Had we needed it, transport by ambulance would have been taken care of, free of charge for us (as it were, car commutes to the hospital could also be reimbursed).
During the chemiotherapy, if he had any side effects (his immune system being weakened, any normal children’s disease basically required him to be hospitalised to be given full anti-biotic treatment), we’d call up the hospital and just come around. Either of us could spend the night with him as needed. We never spent a dime.
After a year at the specialised hospital, ongoing re-education was moved to another institution specialised in home and school interventions. In practice, a full team of 5 doctors or specialists come to see him over the week, either at home or at school, to continue his treatment (such follow up, possibly less intense than at the beginning, will be needed until he reaches his adult size). Of course, they manufacture braces and other specialised equipment for him and provide it free of charge to us.
Check up exams take place every 3 months, with all the appropriate exams (usually including a MRI), and we’ve never had to wait for the appointments. Again, no cost for us, no funds to be fronted.
When he relapsed, our doctors considered all available options. In the end, the most promising technology was in another Paris hospital. Such technology, linked to nuclear research, exists only in 3 places in the world, one in Boston and one in Switzerland, so the French system itself was able to provide a cutting edge option. But had we needed to go to Germany, the UK or even the USA for treatment because that’s where the best hope was, the costs of that would have been covered too by French social security.
Now that our son is in first grade, he has the right to special help for handicapped children at school (a fairly recent law), and he now benefits from part time help – a person who is around about 20 hours per week to help him do his work and catch up when he is absent for his therapy. This is paid by the city of Paris and the ministry of education.
Oh, and as he is officially handicapped, I recently discovered that we actually benefit from an additional tax break (in France, the taxes you pay are roughly divided by the number of people in the family; the handicap counts as an additional person for that purpose).
So, we did not have to spend a single cent. We got support to be available for him. He gets top notch treatment. We never had to wait for anything. And this is available to absolutely everybody in France, irrespective of your job, age or family situation. If you are badly sick or injured, you simply do not have to worry about money at any time, nor about lack of care.
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