The best system – but at a cost

France

Four years ago, our daughter Grace, then aged one month, was taken ill with a life-threatening bronchial virus. She was admitted to the largest Paris children's hospital and given excellent care, in a wing full of other babies and toddlers struck down by an epidemic of the same illness.

Each day more and more babies were admitted; each day, more rooms and staff were made available to treat them. After eight days, Grace came through with flying colours. Her care was paid for directly by the state health service (about 80 per cent) and our private insurance (20 per cent).

A little while ago, our friend Monique found a lump in her breast. She made her own appointment to see a specialist in Paris the same afternoon and she was sent for scans the next day. To her immense relief, she was given the all clear.

The total cost of Monique's rapid examination, and instant peace of mind, including the scan, was about £80. She had to pay the whole amount up front. The French health system eventually refunded most of the cost; Monique's private insurance paid another part. She covered the rest – maybe £25 – out of her own pocket.

The stories illustrates some of the benefits of healthcare in France – flexibility, choice, the mixture of state and private funding, rapid response, excellence of care and generosity of provision – which have persuaded the World Health Organisation to name the French system the best in the world for the last two years.

The government health scheme – the Sécurité Sociale or "Sécu" – covers the bulk of the cost of healthcare: 70 per cent of the cost of a doctor's visit, for example, so long as he or she charges the officially agreed, "conventionné", rates. (If you choose a more expensive doctor, you make up the difference.) You pay the doctor or chemist who gives you a brown-printed form and you write to the Sécu and ask for your money back.

Almost all French people belong either to a work-related health insurance organisation (a "mutuelle") or have an inexpensive private insurance plan to pay the proportion of costs not covered by the Sécu.Waiting times exist for admission to hospitals for non-vital operations but they are essentially administrative delays; there are no waiting lists as such. France has nine hospital beds for every 1,000 people, compared to 4.9 in the UK.

There are downsides. Each doctor's fee or prescription has to be paid up-front then re-claimed and reimbursed, partly from the government, partly from your insurer. With three children, it is not unusual for us to be £1,000 out of pocket, while we wait for a sheaf of accumulated documents four inches thick to be processed.

Nevertheless, most complaints come from practitioners, not patients. In many respects, it works best for those who are literate enough, clever enough and wealthy enough tohandle the system and its arcane rules. Until recently, the long-term unemployed and those on the mar- gins of society had patchy access. The Jospin government has mostly corrected that.

The glories of the French system come at an enormous cost. France spends 9.9 per cent of its GDP – one in every 10 francs that it earns – on healthcare, compared to 6.8 per cent in Britain and the 8.6 per cent EU average which the Blair Government is now striving towards. The system works well. But so might the NHS if such a large amount of the nation's wealth was devoted to it.