Why France and European payors need private, for-profit hospitals
Few politicians in France are prepared to say that the country benefits from having a large and dynamic private hospital sector. The Socialist government’s plan to cut private sector tariffs further will, in fact, likely send the sector into a nose dive. This, despite the fact that the presence of a large for-profit private sector goes a long way towards explaining why France has one of the world’s very best healthcare systems. Without an active private sector, France would end up with something much more like the English NHS. Here’s why.
Private operators still carry out over half of elective procedures in France. They do so for nearly 30% less than their public counterparts. And they do so with almost no recourse to the huge Migac fund.
Yes, as elective procedure sausage machines, they do have a very different business model from public sector hospitals, which are much more likely to run large accident and emergency operations and which perform basic research. But it is clear that the public sector, particularly when it comes to the back office, is much less efficient.
Similar operators in Germany, Spain and Italy – also working for public payors – are routinely 15-30% more efficient than their public peers.
This matters. Payors can hold up the efficiency and responsiveness of the private sector as an example of what is achievable for public operators. The German public sector has learned a great deal by adopting the best practices of the private sector over the last decade.
The private sector also creates real competition. A French or German citizen’s freedom of choice depends upon the presence of private operators who are more than willing to compete for his business.
Remove that strong and dynamic private sector and you end up with something which looks much more like the English NHS today. For most English patients, choice still remains limited. As countless scandals have shown, nursing quality is poor, particularly for the elderly and chronically ill in long-stay wards.
This reflects the fact that they are in a public system in which management decisions and behaviour often remain in the hands of doctors’ and nurses’ trade unions.
No one is proposing wholesale privatisation. But a mixed delivery model is a sane choice. That simple statement is entirely uncontroversial in any industry bar one.
We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.
