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No medical bankruptcies in France

According to a 2009 study published in the American Journal of Medicine, 62 percent of all bankruptcies in 2007 were because of medical costs, and 92 percent of these medical debtors owed more than $5,000, or 10 percent of their pretax family income.

Most medical debtors were well-educated, owned homes and had middle-class occupations. Three-quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical expenses rose by 50 percent. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001. In summary, illness and medical bills contribute to a large and increasing share of U.S. bankruptcies.

By comparison, in 2008 there were no bankruptcies related to medical bills in France. This is because neither the patient nor the employer foots medical bills in that country. France’s single-payer system provides free medical care for all. Because of this, though, the tax burden on individuals and corporations is much heavier in France than in the United States. It is also worth mentioning that life expectancy is two years longer in France.

Overall, the best medicine in the world is available in the United States, but a greater percentage of the French population has access to good-quality health care, with no individual direct cost and a lower societal cost. Creating and maintaining health-care systems requires countries to balance economic, political and moral issues. How those factors are blended together varies according to each country’s social fabric and/or its leadership.

Which factors do you believe should be given the most weight as U.S. leaders debate how to reform our health-care system? How can we keep medical costs from forcing families into bankruptcy?

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia.

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