Notes on the health system — 1

I’ll confess right away that I’m not particularly knowledgeable about health systems, whether in North America or in Europe. I’ve had personal experience with the health systems of the U.S., Canada and now France, and that’s about it. Never studied them, analyzed them, dissected them. Have no grand solutions to offer.

But I think it would be worthwhile to share some observations of  the French health system since we moved to Daglan. Today’s subject: computerized health records, and electronic sharing of information.

For sake of comparison, consider Ontario, home province of the major Canadian city of Toronto. Newspapers there used up a lot of ink in recording the considerable upset in recent years over Ontario’s feeble attempts to computerize health records. High-priced consultants were hired, people got fired, observers and opposition politicians were shocked and appalled, and not much (it seemed) was really accomplished.

To bring this down to earth, consider a typical visit to my doctor in Toronto. My doctor was always busy, but he was still pretty cheerful, and happy to spend a few minutes talking with me. But in his front office, the two young women who ran the place seemed on the verge of nervous breakdowns, with barely a spare moment to nod at you as you entered, much less say hello. They were juggling thick files, making photocopies, faxing information, receiving information by fax, answering the phone, and generally looking frantic.

Now let’s compare that scene with a visit to my doctor in the neighbouring village of Cénac, 10 kilometres from Daglan. Her secretary or assistant is tucked into a small office, and always seems calm; if I’m making an appointment, I chat with the assistant for a minute or two and walk away with an appointment for the next day or so. When I have an appointment,  the doctor pops into the waiting room and beckons me into her office, where I take a seat.

I give her my health insurance card — my carte Vitale — which contains a computer chip. She inserts the card into a card reader on her desk, pulls up my information, and reviews it. Then we discuss whatever I need (for instance, renewing a prescription); she examines me,  if that’s required; and then she returns to the computer on her desk, where she enters the new information, such as the prescription she is writing. I pay her for the visit, she returns my health insurance card, we shake hands, and I’m off. Calmly, she proceeds to the next patient.

Behind the scenes, a lot is going on — quietly. Central records are updated. Reimbursements are initiated. (While I pay directly for my office visit, either in cash or by cheque, I am reimbursed for a good chunk of the cost. This payment is made directly into our French bank account, with no further action needed by anyone.)

And if I’m picking up a prescription at the pharmacy, pretty much the same thing goes on. I provide my carte Vitale, and the computer tells the pharmacy how much to charge me for the prescription and how much will be reimbursed by the system. (I pay the difference in cash, or with my bank card.)

The verdict? Spending the time and money to computerize a health system properly seems to pay off in the end. At least that’s how it looks to me.

Tomorrow’s posting — a French initiative that’s aimed at detecting problems before they get too serious.

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6 Responses to Notes on the health system — 1

  1. Rob West says:

    Did the patient before you discuss the population of Australia with the doctor?

  2. loren24250 says:

    So far, Rob, we haven’t had that scenario in the doctor’s office. But at the end of the supermarket checkout line? All the time. All the time. And while all the discussion is going on, the shopper is hunting through a purse for a chequebook, or trying to find the store’s loyalty card.

  3. John Ison says:

    Well said Loren. It is hard to believe Ontario (much less Canada) has no comprehensive electronic health record system. In 1982 I worked on an Ernst & Young project to define the health record information requirements for such a system but lack of political will, squabbling agencies and (the) enormous technology costs killed the project. How many millions have been wasted since on antiquated procedures; how many illnesses not treated; how many deaths not prevented. You will be pleased to learn that Ontario now has all drug records on the controversial system and 50% of all health records (5 million people). Getting there after 30 years. Common sense moves slowly.

  4. loren24250 says:

    Thanks for that, John. Glad to learn that Ontario is making at least some progress. Today I plan to be posting a piece on an interesting (to me) illness-detection program in France, screening for intestinal cancers. More later!

  5. D2 says:

    In Ontario the government can’t control the abuse of prescription drugs like oxycontin presumably because you can get multiple doctors to treat you and no one is the wiser. Ontario’s solution? Start banning drugs. An interesting strategy, next they plan to reduce car accidents by taking away cars.

  6. Double D says:

    We divested the popsicle stick business too early.

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