Is Europe's Health Care Better?

(page 2 of 2)

One reason the French system seems able to do it all is its practice of using price controls.

A national fee schedule determines reimbursement paid by the government and by most private insurers. Doctors can charge extra, and more than one-third do. But the low rates set by the national fee schedule—typically less than $50 for a routine office visit—help keep salaries modest. French doctors on average earn just one-third the salary of their U.S. counterparts, says Paul Dutton, an associate professor of European history at Northern Arizona University and author of Differential Diagnoses, a comparison of the French and U.S. health systems.

Despite this, rising costs and an aging population make it a struggle for France to finance its system. On May 29, the government warned that health-care inflation this year is running ahead of projections, threatening to deepen an already worrisome $5.2 billion deficit. In Britain, the National Health Service presents a much grimmer picture. It has provided universal coverage for nearly 60 years and boasts benefits such as drug prescriptions that cost no more than $13 for a month's supply.

Fewer Drugs Covered

Yet despite the government pouring $81 billion into the NHS over the last six years, access to treatment is spotty, and long waiting lists are the norm. In 2005, 41% of British patients waited four months or longer for elective surgery, compared with less than 10% in the U.S., according to London-based think tank Civitas. Limited resources also mean medical care varies widely depending on where you live. Access to life-extending new cancer drugs is especially constrained. As a result, Britain has one of the lowest five-year survival rates for cancer overall: 43% for men and 53% for women, vs. 53% and 71%, respectively, in France.

Many critics of the British system blame the National Institute for Health and Clinical Excellence (NICE), whose mission is to analyze the cost-benefit of treatments to determine which should be covered by the NHS. Some of the new cancer therapies NICE has nixed include Imclone's (IMCL) Erbitux, for colon cancer, Genentech's (DNA) Tarceva, for non-small-cell lung and pancreatic cancer, and Avastin, another Genentech drug used to treat bowel cancer.

The picture is no brighter concerning access to advanced, gene-based medicine. It was only after two women sued for access to the treatment that health authorities approved the use of Genentech's Herpacin for early-stage breast cancer in people whose genetic makeup strongly indicates that they will be helped by the drug. Herpacin costs $44,000 for a year's treatment.

Still About Money

A further downside for residents of Britain: The cash-strapped NHS places less emphasis than the U.S. or France on preventive care. Annual physicals aren't insured. And screening programs are less generous than in the U.S. So despite the fact that pap smears can help detect cervical cancer, the second leading cause of death for women, they are only offered once every three years, as opposed to the recommended annual test in the U.S.

What neither the French nor the British system can overcome is the stark math of cost-benefit analysis. A cancer drug like Avastin, which can extend a patient's life by a few months, costs $48,000 annually per patient. It's far too expensive, by NICE's reckoning, to provide to all colon cancer patients, so it's available to none. In France, the state pays a portion and the wealthy are free to make up the difference. Money, in other words, buys good health—on both sides of the Atlantic.

Join a debate about nationalizing U.S. health care.

Business Exchange related topics:
Health Insurance Reform
Health Insurance Availability
Consumer Driven Healthcare
Health Marketing
Electronic Health Records
European Business

Capell is a senior writer in BusinessWeek's London bureau .