Sunday, September 13, 2009

France's advantage in medical costs

Last week in the Prescriptions blog of the NY Times, there was an interview with Victor G. Rodwin, a professor of health policy and management at the Wagner School of Public Service at New York University and co-director of the World Cities Project, International Longevity Center-USA. He extolled the virtues of the French health care system and how everybody can get affordable health care with little rationing, no waiting lines, high quality, blah blah blah. But what stood out for me was this exchange:

Q. Doctors in the United States complain about having to practice “defensive medicine,” ordering unnecessary tests just to cover any potential charges of negligence later on. Is that an issue in France?

A. No, this is not an important issue in France for two reasons. First, since 2002 there has been a national no-fault compensation scheme. Second, the number of attorneys per capita in France is far smaller than in the United States.

Gee, wouldn't that be a dream in this country, a no-fault medical compensation plan. That and fewer trial lawyers. For all those who advocate a European style health care system here, this is probably one of the biggest hurdles to overcome. Imagine how much less a doctor or hospital can charge a patient if malpractice insurance didn't cost so much. Though people have repeatedly said actual malpractice awards are a tiny percentage of health care costs, the expense of practicing defensive medicine is large though difficult to estimate. Virtually every doctor every day practices some form of defensive medicine, whether it is getting that extra CBC that looks almost precisely like the previous day's or that extra chest X-ray with no discernable difference from before. All in the name of defensive medicine.

Why isn't Congress and the president looking into this potential savings bonanza? Has anybody looked into the political discussions in France in 2002 that led to this no-fault compensation system? Did French lawyers just roll over and let this happen or was there some payback involved? If physicians in the U.S. didn't have to pay $100,000 a year or more in malpractice insurance then maybe physicians' fees wouldn't be so high. If fewer tests and procedures can be ordered and still get the same high quality medical care the savings to the system will be enormous. Why can't we do this? Silly question--it's the trial lawyers' belief in the patient's right to sue the system. Seems like if we had a no-fault system here, then the patient or his family couldn't exact the revenge they seek by suing the hell out of the doctor and hospital. Even if the case is without merit the lawyers turn their greed into client advocacy by demanding compensation. So there you go, one main reason why we could never achieve the economic savings of other countries.

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