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  3. The French share Americans’ distaste for restrictions on patient choice and they insist on autonomous private practitioners rath

The French share Americans’ distaste for restrictions on patient choice and they insist on autonomous private practitioners rath

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问题     The French share Americans’ distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as " socialized medicine. " Virtually all physicians in French participate in the nation’ s public health insurance, Security sociale.
    Their freedoms of diagnosis and therapy are protected in ways that would make their managed-care-controlled US counterparts envious. However, the average American physician earns more than five times the average US wage while the average French physician makes only about two times the average earnings of his or her compatriots. But the lower income of French physicians is allayed by two factors. Practice liability is greatly diminished by a tort-averse legal system, and medical schools, although extremely competitive to enter, are tuition-free. Thus, French physicians enter their careers with little if any debt and pay much lower malpractice insurance premiums.
    Nor do France ’ s doctors face the high nonmedical personnel payroll expenses that burden American physicians. Security sociale has created a standardized and speedy system for physician billing and patient reimbursement using electronic funds.
    It’ s not uncommon to visit a French medical office and see no nonmedical personnel. What a concept. No back office army of billing specialists who do daily battle with insurers’ arcane and constantly changing rules of payment.
    National health insurance in France stands upon two grand historical bargains-the first with doctors and a second with insurers. Doctors only agreed to participate in compulsory health insurance if the law protected a patient’ s choice of practitioner and guaranteed physicians’ control over medical decision-making. French legislators also overcome insurance industry resistance by permitting the nation’ s already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Securite sociale.
    In fact, in France the sicker you are, the more coverage, care, and treatment you get. Like all healthcare systems, the French confront ongoing problems. Today French reformers’ number one priority is to move health insurance financing away from payroll and wage levies because they hamper employers’ willingness to hire. Instead, France is turning toward broad taxes on earned and unearned income alike to pay for healthcare.
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答案 法国人也像美国人一样不喜欢限制患者的选择，他们一定要独立的私人执业医生而不是英式的国家医疗服务系统，法国人把后者看作“社会主义化医疗”而不予考虑。几乎所有的法国医生都加入国家公共医疗保险，又叫做“社会保险”。 他们在诊断治疗方面享有自由，这种自由得到的保护会使受“管理型”医疗控制的美国同行羡慕。但是，普通美国医生的收入是美国人平均收入的5倍以上，而普通法国医生的收入只是法国人均水平的两倍左右。然而，有两个因素缓解法国医生收入较低的问题。法律体系不支持由于医疗事故或过失引起的诉讼，这使行医责任大大减轻；而法国的医学院虽然竞争很激烈，却是免学费的，因此，法国医生人行时如果有债务也很少，而且支付的治疗失当保险费也低得多。 此外，法国医生也不像美国大夫那样要负担非医护人员的高昂费用。社会保险创造了一套高速的标准化系统，通过电子资金为医生开账单收费及给患者报销。 在法国诊所看不到非医护人员也并不稀奇。多好的观念!没有一大堆内勤收费专家每天与保险公司晦涩难懂、不断变化的支付规则角力。 法国的国家医疗保险基于两大历史性交易——一个与医生，第二个与保险公司。医生只在法律保护患者对执业医生的选择、同时保证医生的医疗决策权时才同意参加强制医疗保险。法国立法者还允许法国现有的保险公司管理自己新的医疗保健资金，从而克服来自保险业的阻力。私营健康保险商对这套系统也至关重要：他们作为辅助保险商负担患者在社会保险之外的花费。 事实上，在法国，你病得越重，享受的保险费用就越大，得到的护理和治疗也越全面。像所有医疗保健体系一样，法国的体系也面临不断变化的问题。今天，法国改革者的首要问题是不再通过向雇主和雇员征收工资税给医疗保险提供经费，因为这影响雇主用人的积极性。作为代替，法国将对工资收入和非工资收入同等征税以支付医疗保健费用。
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