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In 1997, a reputable consumer publication issued a list of hospitals delivering low-quality, even dangerous care. Even before this consumer awareness, there was a growing recognition that one aspect of quality problems, particularly with regard to chronic diseases and older persons, is the lack of coordination and case management services for patients. These problems are exacerbated by the anarchic character of the French health system—what might be called the darker side of health care. The $55 000 average net annual income of French physicians—salaried hospital-based doctors as well as GPs and specialists in private practice—is barely one third that of their US counterparts ($194 000).

When patients become very ill in France their health insurance coverage improves. For example, although coinsurance and direct payment is symbolically an important part of their system; patients are exempted from both when (1) expenditures exceed approximately $100, (2) hospital stays exceed 30 days, (3) patients suffer from serious, debilitating, or chronic illness, or (4) patient income is below a minimum ceiling, thereby qualifying them for free supplementary coverage.

Considered as one of the best Health Care Systems in Europe Physicians in private practice are paid directly by patients on the basis of a national fee schedule. Patients are then reimbursed by their local health insurance funds. Proprietary hospitals are reimbursed on a negotiated per diem basis and are paid on the basis of annual global budgets negotiated every year between hospitals, regional agencies, and the Ministry of Health. As for prescription drugs, unit prices allowable for reimbursement by a commission that includes representatives from the Ministries of Health, Finance, and Industry.

Coverage Outside Canada Many health services outside Canada cost much more than coverage by your Provincial Plan. You are responsible for any difference in cost. Some health services are not insured by the ministry. You will have to pay the full costs for these services. An accident can happen to anyone, even during a very short business or recreational trip. Extra insurance should be purchased before you leave your Province.

CONS: If you need a surgery in Canada, your Doctor will put you on a waiting list, no exceptions. When it is your turn, you receive the surgery that you need. Triage can play an important role;this keeps the cost down. If the type of surgery that you need has been used up for this year, you will then be referred to a hospital in that Province that has an opening for your type of surgery.Travel costs are payed. In some cases overloads are sent to USA hospitals for surgery's. A referral by family doctor required to see specialists. It has been our experience that once you get in to see a specialist the wait is not too long. Family doctors are good about referrals so that you can get into the system as early as possible. Shortage of doctors caused by brain drain to the US and mistakes made by the College of Physicians and Surgeons who control the number of medical student admissions and residencies available to immigrant doctors. Travel costs to see specialists if you live away from u

THE PROS: No doctor bills, no hospital bills, no co-pays. No one is excluded. Excellent public health, preventative services, free mammograms, dietitians, diabetic nurses and nurses for home visits for new mothers, the chronically ill and the elderly. Emergency transport by air or ambulance is provided for a minimal charge in most Provinces of about $60 or so. Low health premiums Supplemental policies are allowed for dental and other misc. items but by law can not include any services provided by the basic provincial health plan. Doctors may not collect fees from patients and also bill the Province for the same service. Doctors may opt out of the system. Very few unnecessary surgeries

Canadian Health Plan Instead of having a single national plan, we have a national program that is composed of 13 interlocking provincial and territorial health insurance plans, all of which share certain common features and basic standards of coverage. Federal support ,the total federal contribution to national public health spending (what all governments spend) is about 40% . Provincial and territorial governments are responsible for the management, organization and delivery of health services for their residents. Their cost share the remainder or about 60% .

WHAT HAPPENS IN 2014 *State health insurance exchanges for small businesses and individuals open. *Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange. *Health plans no longer can exclude people from coverage due to pre-existing conditions. *Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine. *Health insurance companies begin paying a fee based on their market share. WHAT HAPPENS IN 2015 *Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services. WHAT HAPPENS IN 2018 *An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverag

WHAT HAPPENS IN 2012 *Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care. *An incentive program is established in Medicare for acute care hospitals to improve quality outcomes. *The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.  WHAT HAPPENS IN 2013 *A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care. *The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016. *The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals ea

Medicare provides 10 percent bonus payments to primary care physicians and general surgeons. Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients. A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care. Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare. Employers are required to disclose the value of health benefits on employees' W-2 tax forms. An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted. Insurers will be barred from excluding children for coverage because of pre-existing conditions. Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college. Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014. A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014. Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on