By Ross Tieman

How is it that France manages to have the world’s best health care system (according to the World Health Organization) yet spends no more, as a percentage of national wealth, than the US?

Not only does France’s system rank higher on quality, but it covers all 62m residents, whereas the US census bureau reported in August last year that 45.7m Americans, 15.3 per cent of the population, had no health insurance.

One striking element of the French system is the extent to which it is built upon ‘commercial’ business models. Whereas in the UK, the flow of national insurance contributions into the National Health Service is indistinguishable from taxation, in France health insurance clearly buys treatment.

“Whenever we introduce this,” says Clare Dollery, a consultant cardiologist at the Heart Hospital in London, “lots of clinicians come up to me and say, ‘This is the sort of information we have been asking for for years.’ “The information is a set of data showing the clinician team’s activity, its broad costs, whether or not it is making a profit against the tariff – the price the National Health Service pays hospitals per procedure or treatment – plus, crucially, a lot of data on quality.

These are as diverse as infection and readmission rates, length of hospital stay, survival data and, for example, the time elapsed between a heart attack patient arriving and the coronary arteries being opened again, and how that compares with other hospitals both domestically and internationally.