My visite médicale was a farce. The doctor weighed me, checked that I still had a spine, asked if I was averse to being stood against a wall and sprayed with a high-power hose of cold water (er, yes), and ticked a few treatments on the spa’s menu.
I saw that he had ticked two sessions of aquagym, which sounded a bit strenuous.
‘Can’t I exchange those for seaweed bubble baths?’ I asked.
‘OK, if you prefer,’ he said, and made the change. My highly scientific medical prescription was complete.
While I was simmering away in my fishy-smelling tub, I tried to calculate what all this was costing. If the spa had, say, a hundred guests a week for fifty weeks of the year, and all of them paid twenty euros to see the doctor, that came to a hundred thousand euros a year. The state refunds only 70 per cent of medical expenses for most adults, but even so that was a hefty sum, just at this one spa. And if only a tenth of the elderly guests got their whole treatment paid for, you could probably double the cost to the state. If you added on the national-insurance cover paid by the state for the spa’s employees ... my mental arithmetic fizzled out as I did a typical French shrug (very easy to perform when you’re lounging in a vast bathtub) and decided it wasn’t my problem. I had no complaints about the French health service at all.
Big Boobs
The government has taken some steps to reduce health spending by encouraging the use of generic drugs and cutting the list of refundable medicines. But no government would dare to get too tough on health for fear of losing the next election and/or provoking mass demonstrations.
So as not to appear totally inactive, the health minister announced a crackdown on medical fraud. Some of the examples of health cheating quoted in the press were very revealing.
One woman had been going to see various doctors seventy-five times a month, and getting prescriptions for an average of twelve boxes of antidepressants per day. Another woman had tricked a doctor into prescribing a breast enlargement after claiming that her boobs had shrunk after an accident. But these frauds are only cases of people pushing back the boundaries of what is legally, acceptably available on the national health. It is perfectly acceptable for a woman to have a breast enhancement paid for by the state if her boobs are not symmetrical enough to be shown off on a French beach.
And France is only now, and very slowly, introducing a scheme which will force people to register with a single general practitioner. In the past, people could have several GPs if they wanted, and visit whichever of them could offer an appointment at the most convenient time. Also, because doctors are paid per consultation, they can be tempted to outdo one another in generosity in an attempt to hold on to their fickle patients.
A friend of mine, who had just qualified as a doctor, went to do a holiday replacement for a GP in a large Breton town. On her first day, a man came and told her he was having recurring headaches and needed a CAT scan to make sure he didn’t have a brain tumour. My friend said that it might be better to examine him, discuss possible causes and maybe do some other tests first.
‘Docteur X’ (the woman my friend was replacing) ‘prescribed one for me last month,’ the man said.
‘You had a CAT scan last month? Do you have the results with you?’ my friend asked.
The man lost his temper, and said he was going to visit Docteur Y, who had a reputation for knowing how to look after his patients properly. He stormed off to get his prescription for a repeat brain scan elsewhere.
This is an extreme example, but my friend said that lots of the patients she saw came with a shopping list of (frequently very expensive) drugs that the regular doctor always gave them without putting up any resistance. The doctor’s surgery was just a stop on the way to the pharmacy.
Getting the Green Light
This national drug habit explains why France looks so brightly lit when seen from outer space. Its towns are decorated with green neon crosses indicating the presence of a pharmacy. I live in the centre of Paris, and there are three large pharmacies within two hundred yards of my house. They are not English- or American-style drug stores, boosting their income by selling food, toys and cheap shampoo. These are fully medicalized pharmacies, surviving (very comfortably) by filling prescriptions and selling over-the-counter medicine, as well as certain pharmacy-only brands of beauty treatment and health supplements.
The pharmacies have a total monopoly on the sale of anything at all medical. I recently had a chronic toothache while away for a weekend in Normandy. It kept me awake all Saturday night, all the more so because of my annoyance when I found that I’d forgotten to bring any aspirin with me. On the Sunday morning, I went to the local pharmacy, but it was closed. I tried all the shops in the town, but none of them could sell me aspirin, paracetamol or any painkiller other than alcohol. Only the pharmacy was allowed to sell them. The address of the pharmacie de garde (duty pharmacy) would be written on the door, the café barman told me.
There was no address, just a phone number to call to find out where the nearest duty pharmacy was. It was 18, the emergency services number.
I phoned, apologized profusely for bothering them with my trivial problem, and was told that the nearest open pharmacy was twenty kilometres away. As I didn’t have a car, it was going to cost me a return taxi ride just to buy a box of aspirin. I was tempted to ask for an ambulance. It might well have worked.
All this because the pharmacists’ lobby is so
