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Catherine Mills, "The More a Health System is Free, the More Efficient and Effective It Is"

Translated Monday 18 April 2011, by David Lundy and reviewed by Henry Crapo

Catherine Mills, economist, social protection specialist, shows how to build a new health system based on solidarity.

Huma: Is the objective of the proponents of the Bachelot law really to privatize our health care system?

Catherine Mills: I would not say they are looking for full privatization. What they want is a basic public service for sicker, older and poorer people, in short for those who cost too much and are not profitable, and a private service for those who can pay. That means the total demolition of our principles of health solidarity, with equal access to care throughout and quality care for all. The idea is to have a "mix", using more and more public-private partnerships. In this neoliberal logic, public and social health spending must be cut and the share held by schemes, which are not part of mandatory contributions, increased. This enables the reduction of such charges in line with employers’ demands to reduce the "cost of labour."

Huma: The commercial sector is proud of achieving the same care as the public at a lower cost. What’s in that?

Catherine Mills: The reforms aim to harmonize the financing of public and private health care by putting the two in competition, and that is aim of pricing these services based on activity. Public hospitals, which are obliged to accommodate all those who private hospitals would never take on because it is too expensive, and which take responsibility for research, heavy equipment, rare diseases, training, are of course very expensive. Private care welcomes anything that can be standardized, easy to treat. This amounts to distorted and unfair competition.

Huma: Another aspect is the narrowing of social security coverage and the growing demand for insurance. What’s your view on this?

Catherine Mills: We’re moving further and further away from the notion of a social security system where people contribute according to their means, and receive according to their needs. As opposed to the idea of covering social needs, the notion of individual risk is promoted; the person who pays more gets better coverage. We are moving towards a multi-tiered system, like the Netherlands, where private insurance companies play a very important role and where selection is made according to the level of risk, major or minor, depending on income, age etc… A structural system of social and health inequality that impacts negatively on health: life expectancy and infant mortality indicators are worse in the Netherlands than in France.

Huma: How would one go about building a health system that is both fair and efficient?

Catherine Mills: First discuss what the health costs are. They will grow in conjunction with the level of development, aging, and this is not a handicap. They contribute to growth (up to 10% of GDP); they create jobs, develop business opportunities in a country and renew the work force. Of course, health spending should be re-directed, particularly towards prevention, health at work, and environmental risks. We need to define social objectives for a new system going towards free care, a 100% refund. Mutual insurance plays another role, especially in prevention. We realize that the more a health system is free, as in Scandinavia, it is more economical in the best sense, with more coordination, monitoring of the patient, better relationships between the hospital and its environment and better health indicators. We must reform the financing of the social security system by modulating the rate of employer contributions according to companies’ employment and wage policy, which would increase resources. In addition, a premium on financial revenues of banks and firms at the same level as the employer contribution to health insurance (12.8%) would yield tens of billions of Euros. Building a new public service also means a departure from the authoritarian governance established by the Bachelot law, focused on the hospital director and which has little regard for the rights of staff and patients. We must move towards new powers for patients, at the hospital and local levels. And faced with ARS [1], to act as a counter-balance, we need regional health foundations, based on needs.

[1Agence Régionale de Santé - ARS - are regional health agencies responsible for the implementation of health policy at the regional level.

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