Wednesday, October 17, 2007

France For Medical Tourists?

France is ranked No. 1 in healthcare by the World Health Organization. Thanks to "Sicko" most people know that the US is ranked No. 37. So the question on my mind during my recent trip to Paris was: can France be a good destination for medical tourists, or is it good just for the French?

The short answer is, France does not look good at least for US medical tourists. Because of its closer proximity it can still serve rich visitors from some other countries, notably the Middle East. From my informal conversations with a lot of the French people I had the same impression that is widely reported in the media - by and large the French are satisfied with their own system even if policy planners are worried about the budgetary gap.

On the last point one thing stood out: almost everyone I talked with said social security paid French healthcare was satisfactory and adequate, but not outstanding. Many said that if cost was no object then they would prefer to go to the American Hospital of Paris. This is a US managed private hospital that does NOT accept the French social security system of payment or reimbursement, and is a favorite among rich Parisians. The reason: it has very attentive staff, ultra clean and somewhat luxurious facilities, and well qualified doctors (many of them working as consultants rather than employees.) I confirmed this in my own tour of the hospital. Rebecca Alliegre who showed me around sounded disappointed when I remarked it was similar to the very good US hospitals I had seen. She said they hope it is better than that. I had actually meant it as a compliment - the top US hospitals are actually great, if hard for patients to get into or afford.

In contrast, I was told the regular French hospitals offer a more pedestrian level of care and attentiveness even if they have the required expertise and equipment. Moreover, none of the hospitals other than the American Hospital has a comprehensive website in English. So online information access to English speaking patients will be a problem, and there may be some spoken language problems for admitted patients as well. For these reasons I'd consider the American Hospital to be the best (perhaps the sole) prospect for US patients.

American Hospital has 180 - 190 beds and is a general surgery hospital. It does all sorts of procedures but none of the "standard" ones popular with medical tourists in very high volume, with the possible exception of angioplasties and corneal transplants.

An aside: I met a very impressive young cardiologist, Dr. Tarragano Francois, who performed 580 out of the 600 angioplasties at American Hospital last year (he does over a thousand in all, the rest being in other facilities.) He mentioned that in France teaching cardiologists (who can train others in angioplasty procedures) need to perform at least 600 angioplasties, and the certification threshold for practising cardiologists is 120 procedures (versus only 75 in the US.) It was also interesting hearing him talk about why he prefers using the latest Xience drug eluting stents manufactured by Abbott Labs, as compared to competing products like Taxus, Cypher and Endeavor. Xience allows better insertion and flows in branch points of arteries, and has a slower and more prolonged delivery of the drug that prevents clots. Very interesting stuff - I wish I had become a doctor.

Back on topic, right since 1956 the American Hospital of Paris is the only JCAHO accredited civilian hospital (not just JCI accredited) outside of the US. It was established way back in 1906 with 19 beds as a way to provide American style and quality care, and originally intended mainly for US expats working in Paris. It has come a way since then, and has upto date equipment, like a 64 slice CT scanner, and a PET scan to be operational next year.

So why is it not suitable for most US medical tourists? The biggest problem is prices. Thanks to a weak dollar, the prices here are about the same as the negotiated prices in US hospitals. My impressions are based on preliminary discussions. Thuy Tien Couty, the Director of Marketing was very cautious about disclosing prices, and she said the list will be available only in mid-November. Other French hospitals are somewhat cheaper, but the differential isn't dramatic, and besides they do not match the service levels of the much cheaper elite hospitals in places like India or Malaysia. Besides, India has super-specialty hospitals with 500+ beds that have deep expertise and quality credentials in almost all the major surgeries sought by medical tourists.

Still, some US patients with private insurance or sufficient means may opt for American Hospital because they would like to enjoy visiting Paris and recuperating here while receiving high quality and attentive care.


Anonymous said...

As a foreigner living in France, I confirm that Paris (and France) is a great place for your health!
One mistake in your article: the American Hospital of Paris DOES accept French social security reimbursements.

Sandip Madan said...

Thanks much for the input and the correction. Do you know why everyone doesn't go to this hospital then? I had asked some people who said the American Hospital of Paris would be their first choice as to why they didn't go there. They replied (erroneously perhaps, going by your statement) that they'd have to pay more out of pocket. I'm not sure I heard it right but I had got a similar impression talking to the hospital folks, and I apologize for any inadvertent misrepresentation.