France and Germany as U.S. Role Models for Lowering Health Expenditures

Abstract

OBJECTIVE: To examine the historical development of the German and French health care systems and how their financing and expenditures might inform policy reform for the U.S. METHODS: Available OECD data on health status, health expenditures, and medical supply factors in France and Germany are presented as comparisons to the U.S. Structural characteristics of each countries systems were explored based on a literature review of historical context and financing of their healthcare systems. Indicators of health expenditures such as hospital utilization, physician remuneration and pharmaceutical costs were compared to the U.S. RESULTS: The German sickness funds model of insurance differs from the French reliance on national health insurance. The U.S. spends a much greater percentage of GDP, has much higher health expenditures per capita than its counterparts, and a lower proportion of U.S. residents have health insurance than France and Germany. The main drivers of health expenditures in the U.S. include administrative costs of operating the multi-payer system, lack of price regulation, privatized costs in medical education, and higher physician salaries and pharmaceutical costs. DISCUSSION: The experience of national health insurance systems in Germany and France shows that expanding risk pools for health insurance can simplify systems, provide coordinated care, decrease health expenditures, and prohibit incentives to market to the most affluent privately insured patients. To emulate the successful French and German systems there would need to be a major restructuring of the U.S. healthcare system perhaps creating not-for-profit, private entities within an existing public program, a model similar to the German sickness funds.

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