Single-payer programs also control costs

The French health program uses gatekeepers to hold the cost of care down, according to David Hogberg.

France does have a universal, taxpayer-funded, government-run health insurance program, but it’s been putting primary care physicians in charge of a “coordinated care pathway” care management system since 2005, Hogberg said today.

Hogberg, a health policy analyst at the National Center for Public Policy Research, talked about the French health care system today at a Senate Health, Education, Labor and Pensions health subcommittee hearing on “what the U.S. health care system can learn from other countries.”

The hearing turned into a referendum on the advantages and disadvantages of government-run health care programs.

Hogberg — who represented an organization typically described as conservative — said government-run health programs in other countries often use the same tools that commercial health insurers use to manage costs in the United States.

Even though health care is much cheaper than care in the United States, the French government health care system has been running a deficit since 1988, Hogberg said, according to a written version of his testimony.

In 2005, the French government health program tried to control costs by adding a “coordinated care pathway” gatekeeper system that’s run by primary care physicians. 

A patient who sees a specialist without getting a gatekeeper referral must pay a higher percentage of the bill out-of-pocket, Hogberg said.

The French government health program has set a fixed physician reimbursement rate — but physicians can charge higher fees, and, in cities like Paris, about 80 percent of the physicians charge higher fees, Hogberg said.