France's health care system
===========================

* Irfan A. Dhalla MD
* Sarah Thomson, MSc

*   © 2008 Canadian Medical Association

The news article by Christina Lopes on France's health care system1 may mislead *CMAJ* readers in 2 important ways. First, Lopes states that “there is far more private money in France's system than [in] Canada's” and that “privatization of the [French] health system isn't an issue. It's a long-established fact.” Neither of these statements is true.

Total health expenditure per capita in these 2 countries is almost identical after adjustment for differences in prices: US$3326 in Canada and US$3374 in France in 2005.2 The percentage of total health expenditure borne by the public purse in 2005 was actually higher in France (79.8%) than in Canada (70.3%). Even after the introduction of user fees that will be ineligible for reimbursement via private health insurance, private financing will play a smaller role in France than it does in Canada. Notably, the publicly financed system in France covers prescription drugs whereas the Canadian system does not. Readers interested in learning more about the French and other European health systems could start with the country reports produced by the European Observatory on Health Systems and Policies (available online at [www.observatory.dk](http://www.observatory.dk)).

Second, Lopes argues that it may be “economic suicide” not to “limit health care access to a populace who have grown used to Michael Moore's ideal of access to free health care as a fundamental human right.” We are unaware of any evidence showing that “free health care” leads to a country committing economic suicide. On the other hand, there is reasonably good evidence showing that the introduction of user fees results in patients neglecting to see their physicians when they need to, discontinuing prescription medications prematurely and suffering worse health outcomes.3,4

## Footnotes

*   **Competing interests:** None declared for Irfan Dhalla. Sarah Thomson is employed by the European Observatory on Health Systems and Policies on a part-time basis.

## REFERENCES

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2.  2. Organization for Economic Co-operation and Development (OECD). *OECD health data 2007: statistics and indicators for 30 countries*. Paris (France): OECD Publishing; 2007.
    
    

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4.  4. Rasell ME. Cost sharing in health insurance — a reexamination. N Engl J Med 1995;332:1164-8.
    
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