Annie Jullien-Pannelay (E05), Principal at Economist Intelligence Unit: 'French and British Healthcare Systems Don't Share the Same Goals'

Which countries offer the best cover for their patients? Annie Jullien-Pannelay (E05), principal, Healthcare division, Economist Intelligence Unit (EIU), shares her views on French and British healthcare systems.

ESSEC Alumni: How do you measure the efficiency of a healthcare system?

Annie Jullien-Pannelay: The WHO uses a method called DALY which subtracts the number of years lost due to illness, handicap, or early death from life expectancy figure. At EIU, I use indicators and comparative studies which include diverse data sources such as costs or the inequalities in access to health according to gender, age, or social origin. I also include the patient satisfaction level, which makes analysis more complex. The French tend to judge their system more severely than the Americans, but according to objective criteria, the French Social Security works better.

EA: Is the UK among the best performing countries?

A. Jullien-Pannelay: The UK controls its costs well, with expenditures of $4,348 per person per year, compared to $9,304 in the US (source : EIU, 2014). However the budget is not balanced and a £2 billion deficit is expected for 2015. In addition, some indicators show poor stability performance: cancer treatment, especially lung cancer, could be improved.

EA: Any explanations for this mixed review?

A. Jullien-Pannelay:  It's probably a consequence of the National Institute for Health and Care Excellence policy, which consists of listing the drugs and treatments covered by the NHS that are considered cost-efficient. In other words, the NICE decides how much society is ready to pay to extend a citizen's life; between £20,000 and £30,000 for every additional year. This precise calculation could however be adjusted in relative to the illnesses. The NICE guidelines, which are very strict when it comes to innovative, and often costly treatments, have resulted in the creation of a special fund to cover costs. And here again the existence of this special fund has been questioned for financial reasons.
In France, there is a different approach: a Transparency Commission measures the benefits of a drug, and then the Health Evaluation Committee sets the price. This approach values the level of innovation more than cost. In France, life does not have a price.

EA: Beyond the NICE guidelines, how does the NHS work?

A. Jullien-Pannelay : The key idea is Don't waste a penny on unnecessary appointments. The General Practitioner is the gatekeeper. He updates the medical files, available online to every healthcare professional, and he prescribes any appointment with a specialist. He doesn't make visits and doesn't work week-ends. During the week-end, patients can call 111 to check if their situation requires urgent care; if it is the case, the emergencies take over.
Another way to avoid unnecessary calls is to sell drugs like aspirin or paracetamol without any prescription in supermarkets or chain pharmacies, at a low price. Same thing for glasses: no need for an ophtalmologist for a renewal, the optician can decide.

EA: Does that mean the patient is left to his own devices?

A. Jullien-Pannelay: Let's say he is made accountable, for his own good! Take diabetes: The NHS offers patients to follow workshops on the consequences of the illness, on the drugs to treat it, and the benefits of taking them regularly. After a period of five years, you notice a real gap between those who attend and those who don't; the former experience less complications, while the latter show higher blood sugar levels. A patient who understands his treatment and its implications, gets better results.

EA: Is the British system more efficient than the French one?

A. Jullien-Pannelay : According to the OECD's Health At Glance 2015, the UK spends 8,5% of its GDP on health, against 10,9% in France. This comparison however requires a little more explanation: Both countries don't share the same goals because they define them differently. In the UK, what matters is the physical and mental condition, not well-being: when you prescribe a physiotherapy session, the health professional and the date are imposed. In France, you care more: at the hospital you can have a room for yourself with good food. That level of care means higher costs than in the UK, where only the necessary is covered. Is it pragmatism or lack of empathy? Doctors act as technicians, leaving aside the human dimension of their job.

EA: The system isn't as fair as it seems…

A. Jullien-Pannelay : Well it depends. The coverage isn't as broad as in France, but it is completely free. There are no payments or refunds, it's a significant benefit for cash-strapped patients. On the other hand, if you want to avoid the NHS, you bear all the costs. Complimentary insurance isn't widespread. Your medical bill can skyrocket, and the eventuality of a two-tier system can become true.

First published in Reflets ESSEC Magazine n°112. Click here to subscribe.