Friday, January 29, 2010

Money, money, money

My friend and old work colleague John, who is a health economist, commented on my post called French lessons about the differences between the French and UK health systems, pointing out that France spends 11.1% of gross domestic product on health, public and private and the UK spends only 8.something. I did try to reply to his comment but my computer wouldn't play ball so I thought I would start a bit of a discussion about it. Firstly I wondered if this included Over the Counter (OTC) medicines because the French spend une bombe in the Pharmacie. Apologies to my very belle fille, Julie, but they are a nation of hypochondriacs on the whole. Witness the family cold we all had a few weeks ago, Sam started it and reluctantly took a few paracetamols and sniffed up the nose spray I had been given in the German hospital. I got it and as I had just had major lung surgery and was half dead I did take some antibiotics and some decongestant medicine. Apparently when Julie got it she went off to the doctor or medecin and came back with armfuls of medication enough to stock her own Pharmacie. She got better quicker though.

Also I observe that the French have loads more doctors than we do but I have heard that they are paid much less. They certainly seem to have less managers and admin staff as do Germany in my limited experience. So it seems to me that they spend more and that more of it goes on actual patient care albeit lots on medicines we wouldn't always deem necessary. We on the other hand seem to spend millions on managers who we pay to keep patients' costs down and OK I know I spent years defending this on stage, screen and radio but I have had my "the emperor's got no clothes on" moment or my conversion on the road to the Dordogne and Dresden.

And with all of these admin staff we still keep people waiting for hours. Witness Jess and Danny waiting 2 and a half hours to get his dressing changed and also my fellow blogger and fellow sarcoma victim, Dot, who had to wait four hours for her bed to be made ready for her so she could start on her new chemo regime. They knew she was coming presumably! Both in France and in Germany even though I turned up unexpectedly to both hospitals, I got to my bed within 15 minutes.

So let the debate begin and John put me right on my, no doubt, ignorant rantings just like you used to.


  1. Bit more info from me- found an article in BMJ in 2004 which showed UK docs earned on average 80K per annum, French docs 55 and German 45. In 2005 the French govt paid 2646 per head of population and UK 2261 on health. Density of physicians in 1997 in France was 34 and in UK 23.

    The amount of tax paid by the average UK family in 2006 was 27.1% and by the average French one- 41.7%. So you pay for what you gets basically and I for one would be happy to pay more!

  2. Hmmm...think it does include OTC spend (look up OECD health data file oor that). Gawd, the French do like their pills: think they are the biggest pill poppers in the world (ref OECD again). now, why is that? suspect it's something to do with financial incentives to prescribe and pharmacies' ability to do same. As a kid i remember going to a french pharmacy with some gnat bites and coming away with 4 tubes of ointment - one of which had a suspiciously long nozzle ("pour le bum mon amie!").

    French do have more doctors per head of population....why is that? partly (wholly?) because of deal between uk govt and med prof to limit supply of docs to match (more or less) demand for docs from NHS! why should uk docs be guaranteed a job limited by govt willingness to pay for NHS?

    Also, lately, docs have been paid huge amounts of wonga: average consultant pay last year around 120k!!!!!! way more than French and German docs pay.

    re admin/management staff, i think nhs still relatively cheap.

    what i don't understand re you french experience jean is the apparently quick access to things like diagnostic services and docs (although this has vastly improved in england; FROM WHAT U DESCRIBE IT SEEMS LIKE THERE ARE PEOPLE AND EQUIPMeNT UNUSED FOR A LOT OF TIME, JUST WAITING FOR PATIENTS TO TURN UP....oops, caps lock on, can't be fagged to retype...are ther people and equipment just sitting around waiting for people to turn up and use/consult them?

  3. Only just seen this John, well yes I suppose there must be but you get the feeling that there is just a nice flow of people, just the right number somehow, there always seems to be someone in front of you and someone waiting after you but nobody much sitting in waiting rooms- c'est magique!

    It may be something to do with it being a much clearer sort of market- ie you get a pain, you go to your GP ( this is only recent you used to just go straight to secondary) she/he writes a sort of prescription thing - a bit like when you go for an eye test here - and then you can choose who you go to to get the treatment; the ones who give it then get paid accordingly - to a national set of fees and very cheap they are too - about 50 euros for an MRI so no capital charges clearly. So if you ring up the Doctor and he says sorry chum - desole mon ami - its going to be 18 weeks you will vote with your feet and go elsewhere. You can of course ask for advice from the GP about who and where and in our case he does it all for us and contacts the hospital and sets it all up all for his 22 euro fee because he knows we are hopeless English.

    Are you sure our admin is relatively cheap they dont seem to have the equivalent of SHAs, Trusts and PCTs paying very nice salaries thank you - just I imagine people moving these 22 euro fees from one funtionaire to the next

    Vive la difference I suppose but franky its overrated!