Germany, whose health expenditure is comparable to France, has a city medicine with
“decentralized”
management ,
“co-managed”
with health professionals and
“more regulated”
, which could inspire the Hexagon, analyzes a study published this Thursday. Among OECD countries, Germany is number two in terms of health spending (12.7% of GDP), just ahead of France (12.1%), and behind the United States (16.6%). %). Almost all French people are covered by compulsory health insurance, compared to 87% of Germans who can, above a certain level of income, leave it for private insurance, observes this report from the Research Institute and documentation in health economics (Irdes), in collaboration with the High Council for the Financing of Social Protection (HCfips).
The German hospital system appears
“less efficient”
than in France, but the organization of city medicine
“seems to provide lessons
,” summarized the director of Irdes, Denis, at a press conference. Raynaud. The overall density of doctors is
“close”
, but general practitioners represent 56% of town doctors in France compared to 36% in Germany. The majority of individual practices in Germany employ medical and nursing assistants, or interns, on average 5.2 full-time equivalents. This makes it possible to ensure
“a high volume of activity, by reducing medical time per patient by half compared to France”
, underlines the study. At the start of 2022, only 5% of French general practitioners had a medical assistant and 5% another paramedic.
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Fee overruns impossible
The installation is regulated in Germany: doctors must obtain a license, issued by doctors' associations according to health needs, and their distribution is
"much better than in France"
, according to Denis Reynaud. In France, doctors are paid essentially
“per consultation”
, with the addition of a
“flat rate”
which depends on the number of patients followed. In Germany, this flat rate portion is higher and the price of the consultation depends on the procedures performed. Pricing is
“simpler”
(3,000 acts referenced compared to 13,000) and regularly renegotiated.
German doctors receive four times the average salary compared to three times in France, with less significant disparities: general practitioners have remuneration almost equivalent to surgeons, compared to less than half in France. Fee overruns are impossible in the German universal system.
“Monitoring the quality of care is more advanced
,” judges the study. German doctors, controlled by their peers, tend to limit the costs of prescriptions, in particular through the use of generics.