Health care in france

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Health Care in France and Germany

Health Care in France and Germany: Lessons for the UK

David G. Green Benedict Irvine

Civitas: Institute for the Study of Civil Society London

First published December 2001 Civitas email:

© Institute for the Study of Civil Society 2001

All rights reserved ISBN 1-903 386-17-9

Typeset by Civitas in New Century SchoolbookPrinted in Great Britain by Hartington Fine Arts Lancing, Sussex

Page Authors Acknowledgements vi vii

Introduction 1. France and Germany: the Consumer’s View 2. France: the System 3. Germany: the System 4. Lessons for the UK Glossary Notes

1 3 28 52 77 83 90


David G. Green is the Director of Civitas. His books include Power and Party in an English City, Allen& Unwin, 1980; Mutual Aid or Welfare State?, Allen & Unwin, 1984 (with L. Cromwell); Working-Class Patients and the Medical Establishment, Temple Smith/ Gower, 1985; The New Right: The Counter Revolution in Political, Economic and Social Thought, Wheatsheaf, 1987; Reinventing Civil Society, IEA, 1993; Community Without Politics, IEA, 1996; Benefit Dependency, IEA, 1998; An End to Welfare Rights,IEA, 1999; Delay, Denial and Dilution, IEA, 1999 (with L. Casper); and Stakeholder Health Insurance, Civitas, 2000. He wrote the chapter on ‘The Neo-Liberal Perspective’ in The Student’s Companion to Social Policy, Blackwell, 1998. Benedict Irvine is Project Manager of the Civitas Health Unit. After studying law he completed a master’s degree in comparative European public administration at theCatholic University of Leuven, Belgium. Before joining Civitas he worked as a researcher in the European Parliament. His areas of interest include citizen participation in public policy making, particularly in health care and social housing provision. He also holds degrees in music.


A special thank-you must go to all our interviewees—in Paris, Munich, Berlin and London—whowillingly gave up so much of their time. For the assistance given at the beginning of this project, we thank the social affairs staff at the French and German Embassies in London. We are also grateful to Dr Reinhard Busse of the European Observatory on Healthcare Systems and Professor Juergen Wasem of the University of Greifswald, who provided very welcome technical advice about German healthcare. Finally, we must thank those who participated in the anonymous refereeing process, whose constructive comments have certainly improved the finished product. Naturally, all remaining errors are our own.



‘I saw a long queue, so hopped on the tube and went to a different practice.’ ‘She was rather ill-tempered so I never went back.’ ‘The facilities were drab, so I wentto a different one next to my office.’ ‘I felt rushed at his practice so didn’t go back.’


hese were some of the remarks made by German consumers of healthcare in surveys conducted for this publication. If anything, the French were even more demanding. One French woman we spoke to told us that she had found some of the nursing staff in a French public hospital ‘rude and uncaring’. We pressedfor the details and discovered that her main objection was that the nurses had not knocked before entering her private room. Such high expectations were typical in both France and Germany. In the UK our expectations are much lower. There are many publications which compare healthcare systems and analyse the differences between them, but the special focus of this study is on health care in Franceand Germany from the vantage point of the individual consumer. What are the realities of each system for ordinary people trying to earn a living and raise a family? And what are the lessons for Britain? Chapter 1 describes what our French and German interviewees told us. Separate chapters are then devoted to the systems in France and Germany, and in the concluding chapter, we suggest some...