LONDON – Since he became a medical student in 1947, Walter Holland has witnessed and participated in the evolution of England’s health care system for over 60 years.

The 80-year-old emeritus professor of public health medics at London School of Economics and Political Science shook his head and said such “scandals” as the ones reported by BBC should not have occurred.

According to BBC reports, one-third of the 154 hospital trusts in England failed to meet child protection training standards, and 63 percent of those trusts did not do enough to ensure surgeons maintained the skills needed to operate on children. Meanwhile, it was recently discovered that Royal Cornwall Hospital’s Trust and its Stafford Hospital have not been reporting some of the errors it made.

“The problems,” he added, “are partly because of the low quality of management, partly because of the investment, partly because people don’t care, it is partly because people believe we should spend more money on glossy pieces of machinery … rather than to be concerned with the simple things such as looking after people.”

In the U.S., health care is a money issue where an individual receives health care services based on his or her insurance plan. In England, however, the universal tax-funded health system allows everyone in the country to be eligible for “free delivery of health care,” and it provides access and coverage regardless of the person’s income level or age.

“The state has been providing a safety net, or funding support, for those people (who are not able to pay),” said Martin Knapp, professor of social policy at London School of Economics and Political Science.

Besides free health care services, many patients, including the over-60s and under-16s, are also exempt from paying £7.10 per prescription drug. Doraan Hodgkins, an 81-year-old Lincolnshire resident visiting London on vacation, received prescriptions for free because she is over the age of 65 and said she is happy with the health services.

“Otherwise, it’ll be 49 pounds a month if I have to pay,” she said. “If you need (health care services), it’s there and you’ll get the service you deserve.”

On the other hand, Hilary Goldwin, a 36-year-old London resident who lives near Hyde Park, said it is excellent to think there are emergency and off-care treatments available, but the service could be improved a lot.

“(The quality of services)’s slightly went down,” she said.

However, the effect of the current global economic downturn has slowly reached into England’s tax-funded health care system. The National Health Service, the United Kingdom’s state-run service, survives on a budget based on a five-year commitment. The current health funding is covered based on the decision made a few years ago, so the current recession, at the moment, should not affect the funding that is available, unless the public finance gets into such hard times that the government decides to cut the budget.

Holland said that although it is unrealistic to say how the current economy is hurting health care since the recession has yet to work its way through, one definite impact is unemployment. With the job market shrinking, however, the government’s revenue decreases as people cut their spending and ability to pay tax, which is a major funding source for health care.

Holland said one of the most profound effects on healthcare is the gross disparity between the rich and the poor. The U.S. and the U.K. have the greatest differential now between the two groups, and the U.K. is less healthy now than it was in the ’70s when that disparity was much smaller.

“This could be that the recession will actually diminish the disparity,” Holland said.

Also, unemployment itself has a negative impact on health. People who lose jobs, people who have low incomes and people who have stress are more likely to need health care services, Knapp said. They are not contributing taxes, but they may be making bigger demand of health care services.

As a believer in public health, Holland emphasized the importance for government to pay attention on preventive and environmental measures, which will have greater effect on health.

“Stop meddling with health service,” he said. “It will be far better to spend more money on improving housing than just building hospitals.”

PARIS – The ultimate mission for hospitals is to serve the public’s best interest. Walter Holland, emeritus professor of public health medics at London School of Economics, illustrates this statement best. He said, “Health care is a human right, not something to make profit out of.”

But when the system itself is adding pressure to public hospitals and forcing them to compete with private health care providers who have the luxury of being selective, should the public hospitals choose to be ethically correct or try to survive a deficit at all cost?

Sebastien Chaniac, a 35-year-old French man who currently resides in London and has health care in both countries, said the health care in England is more efficient but patients receive less individual services and attention. It is not as efficient in France, he said, but people get full attention and more services.

“There’s too much investment putting into (the health care system),” he added. “The French expect too much from the health care. They often abuse it.”

The current French health care system is one of the most expensive in the world. It provides universal coverage, but the difficulty stems from the fact that there is not enough control on the actions of private hospitals and independent doctors working outside of public hospitals, said Isabelle Hirtzlin, assistant professor of health economics at University of Paris 1 Pantheon-Sorbonne.

Another problem is the implementation of “people service” payment instead of what’s known as “capitation” payment. In the U.K., general practitioners are paid with capitation payment, in which each doctor receives a payment from the National Health Service that is linked to the number of patients he or she has on the list. In France, it is a completely people-service-payment system in which the doctors receive a certain amount of money per visit.

“That’s why we’re paying so much money, because we give a white check to the health care producer and they write the amount they want,” Hirtzlin said.

The system was once funded solely by social contribution based on wages, but now 50 percent comes from people’s salary and other financial resources, including various taxations such as income tax, consumption tax for tobacco and alcohol, and tax from housing rentals.

Jose Amado Requena, a graduate student from Miami who currently studies at University of Paris 1 Pantheon-Sorbonne, said the question is about accessibility. In the U.S. there is a lack of accessibility, especially for underprivileged communities throughout the U.S., he said, whereas in France everyone is covered by universal coverage. Although he does not think this is something that can be done 100 percent, he said that ultimately the U.S. would work toward a consensus between private and public sector sharing responsibility and cost.

“Maybe something the U.S. has to consider is opening accessibility to everyone,” he said.

The funding of the French system, however, worries some residents of France.

“The system is a little too good and will cause a deficit for state,” said Mickael Leveleux, a 29-year-old Montreuil resident.

“Too much people profiting from the system, and they may not be willing to work because they know they will benefit from the system,” said Jennifer Lancirica, a 23-year-old Paris resident.

Despite the increase in unemployment and layoffs, Hirtzlin said it is too early to determine how the health care system has been hurt by the economic crisis, whether there is significant shortage of staff in hospitals and what should be done to prevent the harm.

“It has not arrived yet,” she said. “Everybody knows we’re in crisis, but the consequences have not shown yet. If (President) Sarkozy decides to stop financing health care because of public deficit, then we’ll have consequences.”

What may arrive as the first phase of shortage, however, is the complementary insurance, Hirtzlin said. Currently France’s social security is paying around 77 percent of the health expense, 23 percent from private complementary insurance and 10 percent out-of-pocket payment by patients. Hirtzlin suspected people, as time goes on, will want to pay less for those private contracts or stop subscribing to them, and there will likely be fewer contracts that could lead to shortage in financing.

The efficiency issue which Chaniac, the 35-year-old French man who currently resides in London, mentioned has also become the reason for President Sarkozy’s health care reform, which is to be implemented in 2010. The reform will shift power from doctors to directors of the hospitals, Hirtzlin said, and the civil groups are strongly against it because the reform will bring competition into the public sector.

“But when you look at what’s the competition,” she added, “it’s not pure competition but an administrative competition, which isn’t competition at all.”

The public hospitals currently do not have the right to select patients, but the risk of selecting patients will occur if the government puts the power in the hands of hospital directors. Hirtzlin said the hospitals are beginning to have classifications that set priority of what the hospitals will treat, which can bring in more profit so the hospitals will not go into deficit.

On the other hand, private hospitals, even the for-profit ones, general practitioners and specialists working in the private health care sector are paid by public associates, Hirtzlin said.

“Doctors always send you to a specialist which makes the system more and more expensive,” said Ludivine Leveque, a 23-year-old Paris resident.

While Hirtzlin said it is necessary to introduce more control on what the private sector is doing, President Sarkozy is putting more control on public hospitals, and a lobby group in the French parliament is not making things easier.

The group, composed of 80 medical doctors, is the biggest professional group in the parliament, and every time there is a law to change health care, the group makes it difficult to change the financing of health care.

“I think financial crisis is a good thing for health care in France because it’s going to say, ‘Now we need to do strong regulation,’” Hirtzlin said. “But the problem is that at the moment, the president doesn’t want to because he’s on the right side (of the political spectrum) and the good solution should be to put private insurance to regulate private producers like in the U.S., so that could be a solution, even though U.S. system isn’t ideal.”