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.

Patients end up bearing the brunt of care cost increases by paying the difference between the government rate and the actual billed rate out of their own pockets, Hogberg said.

France also has let insurers introduce private “responsible contract” health insurance plans that use provider networks.

“Insurers will not cover the copayments for patients who do not adhere to the approved network,” Hogberg said.

In Denmark, Hogberg said, the government relies mainly on long wait times to ration care, and it makes getting information about wait times difficult.

The problems with long wait times for cancer care and other forms of medically necessary care have plagued the Danish system for decades, partly because the long wait times are politically tolerable, Hogberg said.

The number of “those who suffer due to wait times each year is relatively small, not enough to have any impact on election day,” Hogberg said.

Patients usually blame the wait times on the doctor or the hospital, not the health insurance system, because they don’t understand how the health insurance system uses wait times to ration care, Hogberg said.

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