The French private hospital association, the FHP-MCO, has revealed that last October it appealed to Brussels against the two tier pricing which means that its members are paid on average 29% less per procedure than the public sector. But are they serious and do they stand a hope in hell of winning their case?
Every year the National Assembly votes through two tariff price lists – one for the private sector and one for the public sector. This is important as the private sector carries out around 60% of all surgery in France. Overall the FHP claims the difference between the tariffs is nearly 30%.
The tariffs are supposed to be converging, but there is little sign that this is really happening. It has been calculated that at the current rate they won’t reach parity until 2089. And rates for surgery (MCO) for the private sector have barely risen at all in the last two years. Private operators have had to swallow any medical inflation.
In practice, we doubt that the French government has much to fear. Firstly, the difference in tariffs, whilst real, reflects the different functions carried out by private and public hospitals. The former specialise in elective surgery and the latter tend to handle more complicated cases and accidents and emergency.
That is beginning to change – many more private hospitals are now allowed to run A&E units, for instance. And some large hospitals are doing complex proceedures. But the divide is still very real. A French University doctor explained to me why the difference existed as follows:
“Firstly, if any case is complicated, if there are serious co-morbidities, it is almost always referred to a public hospital. So are cases where the opration in the private hospital has failed. Secondly, as we do A&E in the public sector, we literally do not know in a university hospital what we will be doing in 30 minutes – contrast that to a private hospitals doing 20 elective hip operations a day.”
It is also worth pointing out that the public sector handles research and education (although it is paid extra for these functions).
So when the French government says in its response that it can demonstrate that the two sectors carry out different roles for different prices it will be very hard for the private operators to prove otherwise.
That doesn’t mean that the private sector is parasitical. On the contrary, its presence acts as a vital spur to the public sector. Recalcitrant public hospitals, unwilling to reform, can and are gently threatened with the removal of some functions.
The bigger problem for the private hospitals is that very few French people believe that the private sector is really paid less. That reflects the fact that going private is slightly more expensive for the French consumer, as the doctor (not the hospital) does make a charge for his time. So a lot of the French are willing to go to the barricades to protect the right of public hospitals to continue to cost them far more money as tax payers.
Overall, it makes perfect sense to strip out simple elective surgery and hand it to the private sector. It certainly saves the French state a lot of money.
