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France’s social security scheme for self-employed workers

17 Oct

In addition to the general scheme (salaried workers), the agricultural scheme, and the special schemes (which cover certain specific lines of work), France’s Social Security system also has a scheme for self-employed workers not involved in agriculture. These workers’ compulsory Social Security coverage is provided by the Régime Social des Indépendants (RSI).

Full article from the Centre of European and International Liaisons for Social Security available here:

http://www.cleiss.fr/docs/regimes/regime_france_independants_en.html

France has the best health care system in the world

30 May

It’s not me it’s Aaron Carroll from healthcare Triage who says that:

 

 

 

 

It’s not that simple

16 May

It’s not that simple.

The US health coverage system would be the most complex on planet earth according to the article referenced below [1].

Indeed the author of the article published in the rubric “perspective” of the new England Journal of Medicine wrote (quote):

“…the ACA was crafted to leave in place as much as possible of the preexisting system of health insurance. The problem was — and is — that this decision meant that reform had to be built on the most complex, kludgy, and costly system on planet Earth. Multiple layers of health coverage — as a fringe benefit of private employment, as compensation for military service, as public charity for the poor, as public coverage for the elderly and disabled, and as a private commodity purchased by individuals in a remarkably dysfunctional market — overlap and intersect to pay for care through a bewildering variety of agents in a system that even experts seldom fully comprehend.” (end of quote).

Until now I thought it was the French system that occupied the top place with numerous special schemes. If you want to have an idea of the French system you can consult the document issued by the French Agency for the Development and Coordination of International Relations (ADECRI) [2].
click to read the document

Anyway, be it in the US or in France, a nation wide health care coverage system unavoidably has to be complex if it intends to be comprehensive.

References:
1- Aaron HJ. Here to Stay — Beyond the Rough Launch of the ACA. N Engl J Med. 2014 May;Available from: http://dx.doi.org/10.1056/nejmp1404194 .

2- ADECRI The French Social Protection System, booklet downloadable from the Agency’s website: http://www.adecri.org. Copyright © ADECRI, 2008.

INDICATORS FOR MONITORING THE HEALTH OF THE POPULATION – FINAL REPORT

11 May

The French government has issued a report enlisting the available surrogates of risk factors, health determinants and health status of the population at a nation’s wide level.
Some experts from the self employed workers social scheme (RSI) participated to the panel of experts.
In many cases, to construct the surrogates the authors of the report plans to use the reimbursement databases of the national mandatory health care insurance schemes. It is the case for example when the surrogate is a recourse rate to a category of treatment or medicine (anti hypertensive treatment; opioid addiction treatment …).
Feel free to consult the report (in French) here:
http://www.drees.sante.gouv.fr/indicateurs-de-suivi-de-l-etat-de-sante-de-la-population,11299.html

and here:
INDICATEURS DE SUIVI DE L’ÉTAT DE SANTE DE LA POPULATION RÉVISION 2013 – RAPPORT FINAL

The French national medical Board incites physicians to produce content on the internet

16 Mar

The French national Medical Board declares in its last Newsletters that Physicians, as a reliable source of information, should be encouraged to produce contents on the Internet. The ethic is the same as in a patient-physician relationship but the advantage is that the patient can takes his time to apprehend and deepen the information given to him by the physician by consulting his website. The National Board incites physicians to be present on the Web as professionals. But Doctors can also have their blogs like every citizen, provided that they do not discredit the profession and its digital reputation. And provided also that they do not use their blog for advertising and for falsely flattering their skill! The Board recommends also the Doctors to stay sober in their presentation and not to request fees in their websites, but I think that that went without saying.

http://www.conseil-national.medecin.fr/sites/default/files/livre_blancdeontoweb2012.pdf

http://www.conseil-national.medecin.fr/sites/default/files/charte_internet_cnom2014.pdf

http://www.conseil-national.medecin.fr/newsletter/2014/3

How we pay our Doctors

2 Mar

Before the health insurances era Doctors were often payed in nature with eggs, chicken or other farm products. Needless to say that they were often poorly paid, furthermore people called them so lately that the care was unable to keep them alive and the doctors lost their patients in the same time. Once the Doctors and the people they cared got the health insurances to be created Doctors received currencies for their services and could see more than once their patients. The issue of payment was transferred to the insurer. In the beginning insurers reimbursed with a fee for service model like the patients did previously. But the increasing amount of money needed made them think of an alternative payment model. And here came the Pay for Performance model.

France has already put in place such a payment model here:
http://www.csmf.org/upload/File/Conv_med/conv_med_annexes_110726.pdf

USA will implement this mode of payment in 2019 here:
http://www.medpagetoday.com/PublicHealthPolicy/Medicare/40568

Developing countries have already experienced these kind of payment here:
http://www.esciencecentral.org/journals/impact-of-pay-for-performance-on-utilization-of-health-services-and-quality-of-care-in-low-and-middle-income-countries.hccr.1000116.pdf

Below are other links related to the way Doctors will be payed in the future:

http://theincidentaleconomist.com/wordpress/can-the-better-care-lower-cost-act-live-up-to-its-name/

http://advocacyblog.acponline.org/2013/07/house-sgr-bill-promotes-medical-homes.html?utm_source=twitterfeed&utm_medium=twitter&utm_campaign=Feed:+AcpAdvocateBlog

http://advocacyblog.acponline.org/2013/04/does-measurement-improve-performance.html

http://doctorscaucus.gingrey.house.gov/news/documentsingle.aspx?DocumentID=364922

http://energycommerce.house.gov/markup/markup-committee-print-amend-title-xviii-social-security-act-reform-sustainable-growth-rate

The effects of Expanding health coverage

8 Feb

The Affordable Care Act (aka Obamacare) is practically a laboratory experiment at the scale of a continent that allows health economists to observe the effects of expending the health coverage to a whole population (a thing that Europeans have done and that they call modestly Universal Disease Coverage, in French couverture maladie universelle or CMU). Starting from his reading of a
Congressional Budget Office (CBO) report the health economist Austin Frakt lists the incentives and disincentives to work that a mandatory health coverage creates. But in my view the point is: does the labor market need workers anymore, with or without health coverage? If it really needs workers then it would be better that they could afford care and rehabilitation, it is the interest of both the employer and the employee. If it doesn’t, the labor market will always consider that the costs are to high.
The blog the incidental economist is about health economics, below is the post with a link to the CBO report:
http://theincidentaleconomist.com/wordpress/cut-out-the-noise-and-read-the-cbo-report/

Health services research

21 Oct

Recently I found a definition of the field I am interested in:  ie the health services research. Wikipedia defines it as ” to examine how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care.” quoting Academyhealth in the references.

Putted more simply, and according to Academyhealth, HSR tries to give responses to 4 questions in the field of health care in a community:

What works?
For whom?
At what cost?
Under what circumstances?

Read more here

 

A health services author blog

12 May

I would like to share an interesting Blog written by a French physician adviser of the French Social Security.

Drug companies use direct-to-prescriber advert...

Drug companies use direct-to-prescriber advertising in an effort to convince prescribers to dispense as written with brand-name products rather than generic drugs. (Photo credit: Wikipedia)

Written in French it gives good advises to insured people but also to care providers for dealing with the administrative rules which, as every body knows, are some times indubitably complicated. I congratulate this health services author for giving a consequent part of his time to the writing of this useful website accessible to the lay person as well as to the professional.
As often when the author of a blog belongs to an administration or a company under the supervision of the government, the blogger seems to prefer to stay anonymous since I was unable to find the name of the author. But nevertheless the content is noticeable since it addresses such sensitive topics as work loss compensation, pay for performance, off label prescription, psycho social disorders at work, disability, generic drugs, new drug approval etc…

More content:

How Europe intends to finance its hospital facilities

18 Apr
image edited to hide card's owner name. author...

image edited to hide card's owner name. author: Arturo Portilla (Photo credit: Wikipedia)

Casemix-based hospital financing systems are now spreading all over European Countries.

Started for the first time in 1966 in the USA because of a concern about the abuse of payment stemming from the Medicare implementation the concept jumped across the Atlantic Ocean and was called PMSI in 1981 in France. The pitfall of such patients classification systems consists in the possibility of manipulating the coding. So physician advisers have to be suspicious when a trend is uncovered without any other epidemiological explanation.

Related reports and articles:

CONFERENCE ON EUROPEAN CASEMIX-BASED
HOSPITAL PROSPECTIVE PAYMENT SYSTEMS: actes_uk

Changes in diagnostic coding may affect data that indicate decline in pneumonia hospitalizations:
http://medicalxpress.com/news/2012-04-diagnostic-coding-affect-decline-pneumonia.html

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