Health Services in France and Germany

 

La falaise, Fecamp, France
Claude Monet (1840-1926)
Photo Credit: Aberdeen Art Gallery and Museums [CC BY-NC]

To ease the burden on its hospitals, France, which has markedly higher levels of taxation to fund its public services than the UK, has invested heavily over the past decade in both outpatient clinics and what is known as "home hospitalisation": more than 7% of all patients formally admitted to hospital are now cared for at home, against 2% in 2006...

In general, however, France's healthcare problems are less severe than those facing the NHS. According to OECD figures, France has 5.7 beds per 1,000 people compared to the UK's 2.4 and an OECD average of five...

In France the waiting time for a hip replacement averages three to four months, while in England about 400,000 people are waiting more than 52 weeks for treatments such as hip or knee replacements. Patients with heart conditions are seen by a specialist within 28 days in Paris, with 70 the longest wait recorded elsewhere. In England, there are more than 340,000 people waiting for cardiology care, with about a third of those waiting longer than the maximum target time of four months.

The time between a cancer diagnosis and the start of treatment in France averages less than six weeks... In England, 18,600 people given an urgent referral for suspected cancer last year waited at least 100 days to start treatment.

Berlin Street Scene
Lesser Ury (1861-1931)
Photo Credit: Ben Uri Gallery & Museum [CC BY -NC-ND]

Germany, meanwhile, has been tackling the joint health and social care challenges in a cross- party consultation process since the mid 1990s - an approach Westminster has never been able to follow, despite the obvious need. Berlin's answer, which everyone admits is still far from perfect, is the Pflegeversicherung - or long-term care insurance scheme. It is funded by mandatory contributions from all employees, who pay about 3% of their salary into the system... 

The scheme focuses on keeping people out of hospital (currently four out of five of the 5 million people in care, two thirds of whom are aged over 85, are looked after in their own homes), improving the home care they receive from mobile care workers and easing the burden on family carers...

(The Observer, 2023)

The parties can't agree

Social care reform is so long-term and expensive that it initially makes sense to get politicians of all persuasions locked into its design. That was the reasoning behind the 2009 reforms proposed by the then health secretary, Andy Burnham. His national care service funded by a compulsory levy on someone's assets once they died really did look like it might happen. Then along came an election and the Tories pulled their support, calling it a "death tax". Labour got its revenge with the May "dementia tax" in 2017...

(Isabel Harding, The Observer, 2023)

...If we were to spend as much on health per head as, say, the Germans or the French, we would be spending up to 30 per cent more. Contrary to claims since 2010 we simply haven't put the money in to achieve parity. Nor have we run health and social care as part of the same system. Nor have we prioritised public health and we have downgraded care in the community. Every closed drugs centre, every lost district nurse, every impossible waiting list for psychological help adds to the NHS burden. Remedying these, together with making use of medical, diagnostic and technological innovation, are the routes out of Gehenna...

(David Aaronovitch, The Times, 2023)

Manna from heaven. Congratulations to Germany on having the wisdom to tackle health and social care by means of a cross-party consultation process. Health and Education need to be taken out of the one party political arena.