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Michigan Universal Health Care Access Network

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France

France is has a population similar to Britain's; 59,330,000 in this case. This is comparable to the Western region of the US, which the Census Bureau measures at 63,197,932. France has an infant mortality rate of 4.51 deaths/1,000 live births, better than Britain and considerably better than the US. France's life expectancy at birth is 74.85 years for men and 82.89 years for women; better by half a year for men and by three years for women.

The per capita GDP of France is toward the high end for European countries at $23,300, and 9.4% of it is spent on health care. This gives a relatively high $2190 per capita, or just slightly more than half of US expenses.

The country has had a national health insurance system since 1928, but universal coverage did not occur until 1978. The French health care system is primarily funded by Sickness Insurance Funds (SIF's), which are autonomous, not-for-profit, government-regulated bodies with national headquarters and regional networks. They are financed by compulsory payroll contributions (13% of wage), of employers (70% of contributions) and employees (30% of contributions). SIF's cover 99% of the population and account for 75% of health expenditures. The 3 main SIF's (CNAMTS, MSA, and CANAM) cover about 95% of the population, and the remaining 5% of the insured population are covered under 11 smaller schemes. The remainder of health expenditures is covered by the central government, by patients' out-of-pocket payments, and by Mutual Insurance Funds (MIF's), which provide supplemental and voluntary private insurance to cover cost-sharing arrangements and extra billings. MIF's cover 80% of the population and account for 6% of health expenditures. The major public authority in the French health system is the Ministry of Health. Below this are 21 regional health offices that regulate each of the 95 provinces.

Patients are free to choose their providers and have no limits on the number of services covered. GP's have no formal gatekeeper function. Private physicians are paid on a fee-for-service basis and patients subsequently receive partial or full reimbursement from their health insurance funds. The average charge for an office visit to a GP and a specialist are $18 and $25, respectively. Private hospitals are profit-making and non-profit making, usually with fee-for-service physicians. Public hospitals employ salaried physicians, who make up 1/3 of all GP's in France. All medical and nursing education is free.


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