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Government control vs. free market

As Congress debates health-care reform legislation, they are trying to strike the right balance between governmental intervention and letting the free market hold sway. Which approach is better? It isn’t always easy to know.

Consider the example of France, where one of the country’s health-care goals is to allocate costly medical equipment-such as MRIs and PET/CT scanners-according to population needs, rather than free-market forces. This type of equipment falls under Article 46 of Hospital Law #70-1318, enacted in December 1970 and later modified.

In 1990, the ratios called for one PET/CT scanner for every 120,000-230,000 people and one MRI machine for every 600,000-1.6 million people. The national average worked out to one PET/CT scanner for every 136,889 people and one MRI machine for every 815,466 people. According to statistics for Europe, France was in second position behind Germany for PET/CT scanner density, and third behind Italy and Germany for MRIs.

More recently, data from 2004 in France showed the country averaged seven PET/CT scanners for every 1 million people, and three MRIs machines per 1 million people. These figures are similar to Great Britain’s, but both countries now trail their European counterparts. Estimates put France’s MRI needs at 12 machines for every 1 million people. Moreover, in 2009 the waiting time for an MRI test in France is 34.5 days or more because of unaddressed equipment disparities between the various regions of the country.

Because technology is a key health-care cost driver, it is logical to assume that France’s approach helps the government contain medical costs. And few could disagree with the goal of providing equal access to this technology to all French citizens. But are the lower overall health-care costs worth the long waiting time for these scans? What do you think?

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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