The French health system

Camilla and I moved to France in 2012, when I was 68 years old. I had been looked after, up until that time, by the British National Health Service (NHS). At birth, during a bombing raid, they put me in an oxygen tent and kept me there for a few days. I weighed 4lb, no problem today, but in 1944 I was dangerously underweight. Hitler missed the hospital, hitting Mitchem Common cricket pitch instead, and I survived being tiny.

I grew up in the 1950s, cared for by the NHS and post-war welfare provision. NHS orange juice, inoculations, half-pint of milk each day at primary school, red and green medicine for illness, and bandages dipped in white plaster for fractured limbs. In those days, there were even NHS dentists. I didn't have much need for the service, just a couple of fractures from falling out of trees and the usual cuts and grazes. In fact, I have been healthy all my life until my sixties.

I worked with large computer systems, which involved lots of travel, lots of sitting in offices and lots of eating and drinking in hotels. I also enjoyed traditional English ale, lots of traditional English ale. The result, a vastly increased stomach size and shortage of breath from a lack of exercise. I was about 61 when my lifestyle caught up with me, and I ended up with a BMI index of some 38 and an English cardiologist staring sternly at me. "You've got about 10 years, but only if you lose weight, give up drinking, and take up exercise." So I did. I pounded away on an exercise bike, ate sparingly and stopped drinking. I got a very good deal on early retirement and started DIY and woodworking.

I first visited France in the early 60s and fell in love with it. The food, the wine, the smell of Gauloises cigarettes, the blouson bleu that all the workmen wore, the metro trains with funny wooden doors. Once I had finished tarting up our house in England, I was looking for a new project. Our mortgage was paid up, Camilla had just retired and our retirement lump sums were sitting in the bank. Lightbulb moment. Why not buy a small house in France, renovate it and use it as a holiday home. We bought a small cottage on a farm in South West France and I proceeded to tear it apart and rebuild it. The problem was that we loved the little cottage, and had some amazing neighbours who treated us like family. Long story short, we are still here.

Like with most elderly people, things started to go wrong medically. Cataracts were developing over both eyes and I was near to giving up driving. Our dear old French country doctor referred me to a hospital in Limoges and they agreed to remove the cataracts one at a time. Limoges is 50 kilometres from us. No problem, here is a prescription for a taxi. The taxi service is fully integrated with the rest of the health service. They not only drive you there and back, but take you to where you need to be in the hospital and liaise with the staff about when you will be ready to return home. You are not usually in splendid isolation in the taxi, they collect two or three people from around the area and bring back two or three people, not necessarily the same ones.

The complete French health service works like that, a seamless co-ordination of public and private provision. I can walk into any doctors surgery, or testing clinic, or hospital and give them access to my full medical history. How can that work? The key, literally, is a small plastic card, my carte vitale. It contains my essential details on a chip and a photograph. Without that, no one can access my medical information. I physically give the card to a doctor or nurse and they insert it into a card reader. That lets them see and update my medical records. Once they give me the card back, they can no longer see my records.

Our GP insists on blood tests every three months for people of our age. They picked up a raised Prostate Specific Antigen (PSA) level and, sure enough, examination found a tiny cancer. Four weeks of radiotherapy and PSA levels have been normal ever since. I still have the tiny pieces of gold in me that they inserted into my prostate as a target for the radio. Not only cured, but wealthier. Next, they sorted out my heart. Three stents and a valve enlargement, all via keyhole surgery, the stents under local anaesthetic. One big downside. As a cardiology patient, you are not allowed salt. I, being a model patient, smuggled in a salt cellar in my wash bag. So, of the 10 years that I had been given, I have just completed 20. This year, they are going to give me a couple of new knees. Six million Euro man, me.

How is all this paid for? It is a typically French combination of public funds and private payments. There are rates set for various treatments and how much you contribute to the cost depends on how rich you are and how old you are. If you are poor and old, you pay little or nothing. If, like us, you are old and reasonably well off, you pay something, but not very much. If you are young and reasonably well off, you pay more, or pay less if you are young and poor. The rest is paid for by the state. There are private hospitals and testing clinics, but prices are set by the state.

Is it perfect? Of course not, but it does show how a well managed mixture of public and private effort can provide a perfectly reasonable service, even in these difficult times. With Britain's NHS about to spend another couple of hundred million on trying to integrate IT systems, it might be time to stand back and look at how the whole system is organised, before spending another shed load of money on a failed IT system.