As noted in the mini-documentary above, there are three key differences between the French health care system and Canada’s:

1) Non-Ideological Approach: In France, patients, not ideology, come first. France has a robust system with government-run, non-profit and for-profit health care
providers. Patients choose a health provider they feel is best-suited to help them and government funding then flows to that provider once the patient has been helped. 

The government is indifferent as to the provider patients choose. This is quite different from Canada where most health services are delivered by government-run facilities. Governments provide facilities with large cheques each year and then ask the providers to do their best. When governments do decide to pay non-government health providers to provide care for patients – for example, a private diagnostic clinic – it is a very political process. This process is often mired with special interest groups protesting the partnership, arguing for the state to have a monopoly on health care service delivery.

But what do patients want? Three things:

– Quality treatment done right
– Treatment in a timely manner
– No large bill after service provided

No patient has ever expressed to SecondStreet.org that their top priority is for the facility that helps them to be unionized or non-unionized. Nor have they indicated a
preference for the legal structure of the provider (government, non-profit, for-profit).

Again, France’s system is set up to focus on what patients want.

2) Activity-Based Funding: As noted above, funding follows the patient in France. Put simply, the government decides how much it will spend for, say, a knee operation and those funds then follow the patient to the provider that delivers the surgery. This type of funding model is known as activity-based funding (ABF) and it is used
widely by developed nations that provide universal health care.

France’s funding model incentivizes health providers to help more patients as it means they receive more revenue. Funding hospitals and clinics this way also encourages them to spend their money on expenses that help patients (e.g. doctors and nurses) rather than things that do not (e.g. more bureaucracy).

Canada’s funding model is known as global budgeting. Again, it sees provincial governments provide hospitals with a large cheque each year and ask them to do their
best. Unlike the French model, each patient that walks into a Canadian hospital isn’t seen as an opportunity to earn revenue, but rather the opposite – a cost. Administrators have to carefully stretch their funding out throughout the year and there are few opportunities to raise more revenue to help patients.

Canada’s global budget approach leads to a completely different set of incentives.

This post by the Montreal Economic Institute provides additional information on activity-based funding – click here. Thankfully, we are seeing activity-based funding being used more in Canada, notably in Quebec and, more recently, the Alberta government announced a switch to this funding model.

3) Local Empowerment: Government-run health providers in France have considerable power to make decisions
locally.

For instance, during our visit to the hospital in Valenciennes, they described how they were able to modify the structure of the hospital to improve efficiency when it came to overseeing patients as they awoke from surgery. This decision was made locally and, because of the activity-based funding model, the hospital could utilize retained earnings to fund the changes rather than having to write to a local health region or the minister of health to seek funding.

But not only that, local decision-making helps create an environment where staff take more ownership of their workplace and the services provided.