France and United States Health Care Policy Comparison

Abstract The efficacy of the social policies of health care has become a topic of considerable debate. This essay examines the nations of France and the United States in order to develop better understanding of the similarities and differences to be found in each system. The evidence shows that both nations are attempting to address the same issue, through different methods, which in turn are based on social policy. This research will be of value to any person studying the convergence or dependency theories. 1. Introduction As technology unfies the world, there is a continuous debate on the efficacy of individual social policies. This essay assesses and compares the Health Care policies found in the France and the United States in order to illustrate the strengths and weaknesses associated with the processesThe essay identifies convergence or path dependency theory in order to demonstrate how different nations approach the same issues. Suggestions for the future will be offered 2. Health Care Policy2.1 OverviewHealth care is an issue that every nation has to address in order to create a stable, profitable internal environment (Fischer and Collins, 2010). Health care policy can be defined as an effort to alleviate ill-health amongst the population. Although health care policy is increasing, some debate its efficacy (Fisher et al, 2010). This literature suggests that varying societal factors including perception and acceptance play a positive role in the establishment of any social or health care policy. In order to explain the development of healthcare policy, two theories are commonly employed: convergence and path dependency (Dutton, 2007). Each of these methods speaks to the cultural need to assert a semblance of cultural impact on the development of national societal institutions such as health care policy. Cnvergence theory is commonly tied to the functionalist approach which speaks to the societal expectations of having to meet requirements in order to survive and continue to operate (Baldock et al, 2012). The essence of this view associates an increase in industrialization with the coinciding resemblance to other already industrialized nations. This suggests that these forms of nations learn from and adapt other countries policies in order to enhance their own development. Alternately, the path dependency theory denotes a ‘history matters’ approach, that states future social decision and influences are constrained and based on past practices (Baldock et al, 2012) . Prior decisions have a limiting impact on future actions, this method of development often is relegated to the already present institutions that society embraces. This definition of alternative development models indicates a defined social impact to any form of policy institution, not the least of which becomes health care and general population well-being. Both the United States and France will be assessed for their health care policy approach, seeking to Understand whether the convergence or dependency models is more influential.2.1.1 Health Care Policy FranceThere has long been a public policy approach in France (Hantrais, 2010). There is a commonly held belief a nationally subsidized health care system provides a methodfd keeping the population healthy (Hantrais, 2010). With a consistent pattern of leadership in the industry, providing a consistent and strong health care France has illustrated a convergence/functionalist approach to the health care issue, often citing their system as a model for other nations (Marmot et al, 2012). In many ways this evidence speaks to the fact that a healthy population enables increased access and opportunity to social benefits by reducing health care costs and increasing spending in other areas. France as a European nation is marked by a larger than average ratio of health spending yet remains much less than their counter parts in the West spend on health care(Marmot et al, 2012). Alongside this popular national support rests that the fact that the population is largely healthy with a average life span two years more than the rest of the word (Marmot et al, 2012). . The French is to manage cost by implementing a system of premium health care levels that are directly associated with a person’s income (Rodwin, 2003). This is a targeted policy that seeks to make insurance as affordable as possible in order to ensure that that each person has access. Further, this limits opportunities for the insurance industry to adjust rates unfairly or at a disadvantage to certain conditions or participants (Rodwin, 2003). This element of control takes away much of the ability for companies to overly profit from the insurance market. With the French system taking on the burden of the majority of medical expenses through a system of reimbursement, the average citizen’s ability to sustain health insurance is higher (Rodwin, 2003). This protection is enhanced and extended to the people who need healthcare the most, making the issue of major illness much more manageable on the economic and social front. Due to the quality of universal healthcare in France, there are very low levels of private insurance, a further indication of the capacity for this system to not only manage cost but provide efficient and dependable care (Marmot et al, 2012). With a public system in place,the need for private insurance in significantly reduced, further ensuring less expense for the average citizen. France possesses a well-developed system of independent and public hospitals (Rodwin, 2003). This wide ranging access to care has been credited with further enhancing the overall rate of health and effectiveness in the nation. Yet, the diverse manner of health care oversight has been cited as an issue (Marmot et al, 2012). With nearly fifty different regulatory agencies to contend with, each faculty has to negotiate an ever-changing environment, which provides a serious challenge to many institutions. A further problem is the rising influence of the pharmaceutical industry, intent on generating profit rather than being concerned with benefiting the people of France (Clarke and Bidgood, 2013). With prescription charges payable, there is anarea of concern Regarding affordability of medicine. In summary Universal health care in France is a nationally subsidized system that reimburses out of pocket patient expenses, based on that person’s rate of income. With a convergent form of policy that seeks to make the French system a global model, the high quality of care denotes a degree of success. However, the high rate of regulation serves to diminish many of the positive elements of the policy. The French system has offered other nations a model of healthcare promising to reduce sickness, thereby decreasing underlying societal cost. In France, there is evidence that health policy supports citizens during times of sickness or injury.2.1.2 Health Care Policy United StatesThe healthcare system in the United States has long been an area of contention within the nation, commonly resulting in politically partisan fighting that diminishes the ability for any system to function (Hoffman, 2008). With the ascension of a liberal regime in the United States, the recent past has wit nessed a shift away from the individual, less regulated, insurance market to a form of universal health care with far more federal regulation. The private market controls the health care insurance market, making the need for supplementary services high in order to meet every expectation (Hoffman, 2008). With the rising cost of health care and a general lack of productive policy, the shift away from the strictly private system has been a rough evolution for many in the United States. With a standing of 50th in the world foro effective health care policy as rated by the OECD there seems to be a suggestion thathe US system has begun to change to match other models, actively incorporating the convergent theory and seeking to emulate the positive health trends Found elsewhere. (Palmer, 2014), There are multiple levels of regulatory oversight in the US system of health care (Gulliford and Morgan, 2010). This is a reflection of the national and state level authorities that commonly find themselves at odds with one another. With this abundance of regulation there is substantial paperwork (Hoffman, 2008). Evidence suggests that there is a potential for politics to play a role in the policy making efforts of healthcare. This opportunity for gain at the expense of the national system is often attributed to the wellbeing of the very people that need it most, the lower earners and single mothers. US federal oversight is conducted by the Department of Health and Human Services, which ensures that the appropriate compliance guidelines are followed by states (Gulliford et al, 2010). This section of governement oversees procedures from county/state level to the national level. In this manner the integration of State and Federal concerns can serve to aid in the implementation of healt h care policy throughout the nation. Yet, it also seems to be the case that there is a potential for conflict among policy makers, leading to a poorer service Medical professionals in the US are licensed under the American Medical Association, with an aim of ensuring a high quality of care and adherence to ethical guidelines (Kominski, 2011). . It has been suggested that the US private system is commonly influenced by the presence of rich or well to do patients or donors (Palmer, 2014). This perception seems justified, as the best performing doctors are often unavailable to the average US citizen, thereby creating an unintentional division of care which is reflected in the life expectancy numbers. Yet, this is a demonstration of the convergent theory at work in the functionalist US society, as the recognition of expanded need becomes apparent; public policy was created to address the issue. In summary The health care policies found in the United States have been shown to be rated as moderate by the international community. Before the shift to the universal care subsidized by the nation, the gap between rich and poor in terms of healthcare had widened. Many people lacked health insurance. In order to address this, recent liberal policies found in the US were formulated but have been much debated. It can be suggested that new policies have succeeded in lowering the rate of people without healthcare insurance, thereby beginning the effort of increasing the health of the population in general. Yet, the regulatory environment found in the healthcare system in the US is often counter-productive. Further, this every area of contention has led to a gap of states that have accepted the new universal care and those that have not, decreasing the impact that they policies have on a considerable number of citizens.2.3 ComparisonThe health care policies found in France in the United States share many similarities as well as considerable differences. For example, the French tradition of seeking social remedies to health issues is sharply differed from the American approach of ‘goes it alone’ fundamentalism (Flynn, 2010). In many cases the expectation that everyone must take care of themselves has led the US health care system to sharply different levels of care in regions, largely based on the underlying income factors of the residents. Conversely, France has long sought to provide a balanced method that seeks to present a useable model to the rest of the world (Fisher et al, 2010). This is best illustrated by the life expectancy rates found in the US of 78.4 and 81.3 in France (Fisher et al, 2010). With numbers supporting the success factors in France over the prior efforts in the US, the American shift to the more universal system is considered a convergence with modern examples such as France leading the way. A factor that both systems share is the high quality of physicians and practitioners that are involved in health care (Palmer, 2014). While the French system is primarily publicly owned and supported, the US policy dictated that many of their institutions are privately owned and operated, presenting further considerations during the transition to universal health care in this nation. This same issue presents itself as a difference between the social policies as the French doctors are paid substantially less than their American counterparts (Palmer, 2014). Yet, the French approach to this issue was to make subsequent education and associated services free to those in the medical profession, thereby reducing the need for the extravagant wages that many experience in the West (Guilliford et al, 2010). This same measure of policy support is yet absent in the American system, which makes a considerable difference as to where and how a student can learn and practice. This literature sugges ts that there is a need to make expenses of the medical learning process reduced in order to present a method of paying fair wage thereby allowing the entirety of the population to receive the same quality of care, regardless of financial position or social standing. The spending levels for medical needs in the United States far outweigh those experienced in French system, demonstrating effective policy (Palmer, 2014). In part due to the rapidly rising cost of health care, the American system was forced to shift to a universal policy in order to slow the impact that this substantial cost on the overall economic outlook for the nation. With both nations providing a social policy of immediate emergency care, there was a widespread perception in the US that this would alleviate much of the lower class medical issues, yet, conversely, this phenomena of utilizing emergency care for routine care served to drastically increase the need for funding from the national level, thereby prompting new policy modelled on systems including the UK and Canada (Palmer, 2014). This is in contrast to the French model, which involves more spending per citizen, but has shown positive performance in response to spending levels. The United States policy of health care has a compulsory insurance mandate this is designed to ensure that each citizen has insurance (Palmer, 2014). Conversely, the French system utilizes a series of reimbursements based on wages in order to supply the same medical services. In some ways, the perception of the US system has been cited as a form of increased taxation on the healthy, with these views stating that they are supporting the poor of the nation. Despite the strength of health care available in the United States, until recently there was a marked increase in the value, with many of the citizens putting off routine care in favour of waiting for emergency, which in turn inflated health costs of every level (Palmer, 2014). However, France overcame this issue by establishing oversight panels that ensure that fair access is assured and that the population has access to the same general level of care. A common component of both nations health care policy is the multiple layers of bureaucrats and agencies that dictate policy (Flynn, 2010). Both nations cite the need to reduce the layers of oversight in order to streamline the process, which would in theory reduce administration costs and aid the both nation and industry. In a very real manner, this evidence suggests that the long term capacity to develop a working system will be found by taking the best of the existing structures and using these as a foundation for growth. 3. Conclusion This essay has examined the social policies of France and the United States in the field of health care in order to evaluate and compare their offerings. The evidence presented illustrates a position of French strength through communal action. With proven records supporting the reduction in health issues, rise in life expectancy and overall positive implementation there is a model for progress. Alternately, the private system once favored in the United States has evolved to a more UK or Canadian style system that requires consumer participation. This recognition and development on the part of the American nation is deemed an example of the convergence/functionalist theory with the country seeking to alleviate many of the social health issues by implementing a system similar to other nations. An area of weakness demonstrated in both societies that have the potential to raise issues in the future is the presence of an over regulated system. With so many different agencies responsible f or the oversight and regulation of the same industry, there is a need to coordinate and simplify the process in order to aid both the consumer and the provider. Further, this area is prone to political partisanship or bias, which in turn has a direct impact on the quality of care and policy that develops. In the end, the social policy of health care has been deemed of critical import for both France and the United States. Yet, just as the nations are culturally unique yet share traits, so too will the health care issue, with both nations seeking to address the same issue though slightly differing means. Only time will judge which has been the better approach. 4. References Baldock, J., 2013. Social policy. 1st ed. Cambridge, UK: Polity. Dutton, P., 2007. Differential diagnoses. 1st ed. Ithaca: ILR Press/Cornell University Press. Feldstein, P., 2012. Health care economics. 1st ed. New York: Wiley. Fisher, K. and Collins, J., 2010. Homelessness, health care, and welfare provision. 1st ed. London: Routledge. Flynn, N., 2010 Social Policy, fiscal problems & economic performance in France, United Kingdom & Germany. London, 1(1). pp. 65-100. Gulliford, M. and Morgan, M., 2010. Expanding access to health care. 1st ed. Armonk, N.Y.: M.E. Sharpe. Hantrais, L., 2010. French social policy in the European context. Modern & Contemporary France, 3(4), pp.381–390. Hoffman, B., 2008. Health care reform and social movements in the United States. American journal of public health, 98. Kominski, G., 2011. Changing the U.S. health care system. 1st ed. San Francisco: Jossey-Bass. Marmot, M., Allen, J., Bell, R. and Goldblatt, P., 2012. Building of the global movement for health equity: from Santiago to Rio and beyond. The Lancet, 379(9811), pp.181–188. others, 2012. Health, United States, 2011: with special feature on socioeconomic status and health. National Center for Health Statistics (US). Palmer, K., 2014. A Brief History: Universal Health Care Efforts in the US | Physicians for a National Health Program. [online] Pnhp.org. Available at: [Accessed 19 Apr. 2014]. Rodwin, V., 2003. The health care system under French national health insurance: lessons for health reform in the United States. American Journal of Public Health, 93(1), pp.31–37. Sauret, J., 1997. Information systems in healthcare Situation in France. Health Cards’ 97, 49, p.27.