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Flashy pharmacies

Paris, FR (View on map)

Being ill is never pleasant but the French can take pride in being quite well off. France`s health care system covers a wide range of treatments and is accessible to anybody living and working in France. Like many other industries in France, health care is managed under strict supervision of the state but they seem to be doing an OK job. Life expectancy is very high, for French women even the second highest in the world.

Claire (23): `For light illnesses and inconveniences, French people may go to a pharmacy without seeing a doctor first`

The flashy pharmacies in the streets of Paris are a good indication for how much French people care about their health. The pharmacies look like commercial medication shops and are at first sight very different from the Swedish Apoteket, a state owned monopoly that serves it customers without any fringes or flashing green neon crosses sticking out of their front doors.

Seeing a doctor
The French have a number of options when they fall ill. Claire (23, photo) introduces me to the principle of automedication, which is suitable for ordinary and frequent inconveniences. It requires light medical treatment with products that can directly been bought at pharmacies. Pain killers, tranquilisers and treatments for colds are included in the over-the-counter offer. Pharmacists are obliged to have appropriate diplomas and often they, rather than doctors, serve as a main source of information for minor illnesses.

If the situation is unsuitable for automedication, people may choose to call 112, SOS M?decins (doctor service outside working hours), their family doctor or to go straight to hospital. Family doctors tend to be easily accessible and if you call for an appointment, you can usually see the doctor the same or the next day. Camille (23) tells me that family doctors often prescribe, or are even expected to prescribe antibiotics, even without medical grounds to do so. Family doctors are also the ones who refer people to medical specialists for further treatment. Patients used to be free to go to any specialist they wanted to see, but since 2004 they can no longer do that without losing the right to get their invoice refunded by the social security. Going straight to the pharmacy does have one major disadvantage: buying medicines from a pharmacy will make you pay the full price, while a prescription from a doctor will give you a close to 100% refund. Automedication enjoys substantial popularity. Christelle (24) does not go to the pharmacy very often. `About once a month at the maximum`, she says.

Habits and conventions
The majority of children are born in hospital. Abortion is legal, euthanasia is not. All French are donors by default, resulting into 99% of the population in fact being donors. Ignorance about this policy may be the reason why only 1% explicitly opted out.

France is fond of taking medicines to prevent, cure or mask diseases. The system of one family doctor for one person had recently been reintroduced to keep a hold of growing expenses in health care. That measure simplifies reimbursement procedures, which before were arranged supplier-by-supplier. At the same time, it will hopefully lead to smaller numbers of people spending time on `recipe hunting` or `medical nomadism`: going to a doctor, or another one and another one, just to get the prescription you want to get. Possibly as a result of these two phenomena, France ranks among the highest consumers of anti-depressants. They are popular among students, to a much higher extent than cosmetic surgery which is becoming ever more popular in Anglo-Saxon countries. Psychosomatic illnesses ? physical illnesses induced by psychological trouble ? are on the rise, and so is medication to relieve symptoms.

Need for change
The French health care system is not only perceived as one of the best in the world, it is also seen as one of the most expensive. It is paid for by income taxes, deductions from gross salaries and taxes on unhealthy products like cigarettes and alcohol. Who earns less, pays less, but a reasonable level of minimum care is guaranteed for everybody, regardless of income. The high toll paid for such an accessible health care service is produced by one of the major achievements of the very same system: people get older and old people are more likely to have health problems than young people. Furthermore, old people who enjoy pensions do not work and do not contribute to covering the increasing costs they produce. The problem of ageing populations is not only applying to France but to most of Western Europe, and not only to the health care system but also to the pension system. The hot summer of 2003, referred to as canicule, killed thousands of elderly French and serves as a worrisome example of what the future of society and health care may look like.

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