Letter From Paris

By Harriet Welty-Rochefort

Paris Kiosque - July 2000 - Volume 7, Number 7
Copyright (c) 2000 Harriet Welty-Rochefort - Used with permission.

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A recent front page article in the International Herald Tribune announced that the World Health Organization, which for the first time in its history ranked the health systems of its 191 member countries, rated France first on the list for providing the best overall health care.

As I read the article, I found myself looking back on some thirty years of health care in France. My family and I have been fortunate not to have had any major illnesses (I knock on wood as I write this) so the doctoring we have had mostly concerns the joyful (pregnancies) and the mundane (colds). Having paid into and benefited from the French system for the past three decades, I can confirm that the system is indeed a good one.

In my first years in France, of course, there were a few things I didn't understand. I didn't know that when you go to the doctor in France, you pay him right there in his office rather than waiting for the bill. I learned this after walking out without paying once - the doctor's astonished look told me something was awry.

I didn't know that after the visit, when you go to get the medicine, you present your prescription along with the Social Security form on which the pharmacist writes down what you purchased and the price. The next step (back in the US unless you've got a nice pharmacist who will do it for you) is that you take the little stickers off each box and paste them on to the Social Security paper which now contains the following information: the cost of your consultation and your doctor's signature and the date of your visit to him, the date of your visit to the pharmacy and the names and cost of the medicine you bought PLUS the little stickers from each and every box of single medicine as proof. In the beginning I thought this was silly and didn't do it. After losing all kinds of money on medicine, I decided that it might be time-consuming but certainly worth the effort.

I learned that the French have different illnesses than we Americans have. For example, when Americans are feeling lousy due to too much heavy food or drink, they say they have a "stomach ache". (If it's too much drink they say they have a hangover - in France this is called a "gueule de bois" but of course you wouldn't tell your doctor that!) The French have "mal au foie" (liver ache). I didn't even know I HAD a liver until I got to France!

I rapidly got used to all of the above and it didn't take me long - especially after I had children - to become a fan of the French health care system. Sure, not everything is perfect in France. There are incompetent doctors, arrogant doctors, doctors who overprescribe, doctors who underprescribe, frustrated nurses, hitches and glitches in the bureaucratic Social Security system. But all in all, if you've got to be sick, France is one of the best places to be. And here, in my book, at least, is why:

--Whenever either of my children were running high fevers, I automatically called the doctor who came to the house. It never even crossed my mind to wrap the child up in a blanket and go sit in some waiting room until the doctor was available. The child stayed warm in his own bed until the doctor arrived. There's only one word for this and it's called "civilization". (I just hope the French will continue to do this. When I was a child in the States, doctors paid house calls as well-ah, the good old days). The charge was slightly higher for the house call, but not significantly. Social security and my husband's "mutuelle" (complementary insurance) paid for 99 per cent of the visit.

--The side benefits of the doctor coming to you is a human quality which can sometimes be endearing. I once had a doctor who strummed on our guitar, thankfully, AFTER diagnosing our ills; another doctor, a friend of ours, is so popular that when he makes house calls he can barely make it from one place to another. "Pierre, you must join us for an aperitif-you can't go yet!" One reason for this is that in addition to being a good doctor and a great storyteller, Pierre thinks nothing of climbing up on a ladder to change a light bulb or get down under the sink to try to find the origin of a leak.

--Both times I was pregnant, I gave birth in French hospitals where in addition to excellent medical treatment, I was given total rest. Each time I was kept eight days!! I must admit that for the second child I was itching to get home. But for the first baby I was happy to be coddled and to put off the moment when I would find myself responsible for this new little creature. Not only that, but the hospital in which I gave birth to my firstborn (the university hospital in Nantes) was spanking clean and served excellent food AND red wine with the meals!! As you may know, the French think red wine (RED, not white, and Bordeaux more than any other red) is good not just for every ill that could assail the human body but also for the morale. It certainly was good for mine! My second son was born at the Hôpital Salpetrière in Paris. The rooms were not exactly out of Architectural Digest painted as they were in yukky shall-I-slit-my-throat-now-or-later green and there was no time for the coddling I got at the University Hospital in Nantes. But, as my husband reminded me, if anything serious went wrong with either me or the baby, I was in a place with the finest emergency equipment available and could be taken care of right on the spot.

--In France, a factory worker and a head of a company can see the same "grand professeur de medicine": the factory worker will pay one price, the company head another. (By the way, in France you choose your doctor, you are not "assigned" to one). Recently my generalist told me I should get a cardiogram just as a matter of routine since I'd never had one. I could have gone to any doctor but decided to go to the Hôpital Broussais to see an eminent heart specialist who over the past twenty years has taken excellent care of friends of mine with grave heart conditions. This was, in fact, a very stupid decision as any doctor could have looked at my (perfect) results and told me I was fine. By the time I realized this, though, I was already at the hospital and it was hard to leave. I watched in horror as people with obviously major problems were ushered in and out; I was ashamed of being in such good health! A technician did the cardiogram and then I was ushered into the Professor's office. He examined me thoroughly, questioned me about my family history (bad news in the heart department).

"I'm afraid I can't do anything for you," he told me, shaking his head kindly. "Your heart is perfect - at least, it's perfect today!" he said. What he didn't say is that it was probably the first time in decades that he'd seen someone who is perfectly healthy. Oh well, it comforted me to know that anyone in France can benefit from superior care like this without it costing an arm and a leg, pardon the pun. The bill for the cardiogram and the consultation with this specialist(whose rank would be the equivalent of the Head of the Cardiology Department at the Mayo Clinic) came to 320 French francs (about $46.00).

--Life expectancy is tops (France ranks first in life expectancy - the U.S. ranks 37th). One of the reasons for this discrepancy may be that almost everyone in France has health insurance and therefore access to care. But there may be other reasons: In the "Letters to the Editor" section of The Herald Tribune, Samir Sanad Basta, the former director of Unicef Europe pointed out some of the contributing factors that the WHO did not mention in its study. It just may be, Basta wrote, that "tasteful diets, extramarital sex, grumbling, yelling, red wine, smoking (especially for teenage girls), tax evasion and work stoppages" all contribute to long lives. His tongue-in-cheek conclusion: "All is not health care or medicine!"

I thought of one more "contributing factor" to longer life expectancy: gun control. The French may grumble, threaten each other, yell, raise their shoulders and cast dark menacing looks but they don't blow each other away everytime they get into a dispute (if they did, there would be no more Frenchmen in France). They can't, because access to guns is so severely limited. Voil=E0 another reason the French live long enough to enjoy all that delicious food and drink (while smoking, naturellement).

Vive la France. Vive the paradoxical French!

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Harriet Welty Rochefort is the author of "French Toast; An American in Paris Celebrates the Maddening Mysteries of the French", published in January 1999 by St. Martin's Press. The book, which the Los Angeles Times called "wise and devastatingly funny", is on sale at all major bookstores. Her forthcoming book, "French Fried, The Culinary Capers of An American in Paris", will be published by St. Martin's Press in February 2001. You can reach Harriet at hwelty@club-internet.fr and can visit Harriet and Philippe's website at http://perso.club-internet.fr/hwelty/

Editor's Note: Dear Readers, while our writers are always delighted to hear and to receive comments, both about their columns in the The Paris Kiosque, as well as your experiences in Paris, they are unable to answer any requests for travel information. Thank you for your understanding.