French health care: viewpoint A--system X?

This article outlines and applies a framework for comparing health care systems put forward by Culyer et al. (A New Approach to the Economics of Health Care (Olsen, M., ed.). 1982, pp. 131-150, American Enterprise Institute, Washington-London). Systems are differentiated by their objectives, finance, ownership, degree of government involvement and reward mechanisms. System X is essentially the market model whereas system Y is the state version of health care provision. Two basic objectives are pursued in the paper. First to describe and analyse the French health care system with the aid of this taxonomy. Second to test the hypothesis advanced by Culyer et al. that countries with one system tend to adopt elements of the opposite system in response to policy difficulties. The evidence presented is inconsistent with the suggestion that French health care is clearly in the system X mould as it contains significant elements of both systems. However, it is suggested that reform responses have taken the French system further towards a system Y stereotype. This observation is consistent with the description of the evolution of health care discussed by Mechanic (Milbank Memorial Fund Quarterly, 55 (1977) 61-78.