Comparison of 

Health Expenditures 

in France and 

the United States, 

PROPEFWOFmE - 1950-78 

PUBLICATIONS BRANCH 

EDITORIAL LWIRARY	 Analytical and Epidemiological Studies 

Series 3, No. 21 

DHHS Publication No. (PHS) 83-1405


U.S. Department of Health and Human Services


Public Health Service


National Center for Health Statistics


Hyattsville, Md.


June 1983

COPYRIGHT INFORMATION 

All material appearing in this report is in the public domain and may be 

reproduced or copied without permission; citation as to source, however, 

is appreciated. 

SUGGESTED CITATION 

National Center for Health Statistics, S, Sandier: Comparison of health 

expenditures in France and the United States, 1950–78, Vita/ and Hea/th 

Statistics, Series 3, No. 21. DHHS Pub. No. (PHS) 83–1405. Public Health 

Services. Washington. U.S. Government Printing Office, June 1983. 

Library of Congress Cataloging in Publication Data 

Sandier, S, 

Comparison of health expenditures in France and the kited States, 

(Vital and health statistics. Series 3, Analytical studies ; no. 21) 

(DHHS publications ; no. (PHS) 83-1405) 

Bibliography: p. 

1. Medical care, Cost of – United States, 2, Medical care, Cost of – 

France, 3. Medical care – United States– Finance, 4. Medical care– 

France– Finance. 1. Title. 11,Series. ill. Series: DHHS publication ; 

no. (PHS) 83-1405, 

RA410,53.S26 338,4’736210944 81-11078 

ISBN 0-8406-0224-3 AACR2 
National Center for Health Statistics 

MANNING FEINLEIB, M. D., Dr.P.H., Director 

ROBERT A. ISRAEL, Deputy Director 

JACOB J. FELDMAN, Ph. D., Associate Director for 

Analysis and Epidemiology 

GARRIE J. LOSEE, Associate Director for Data 

Processing and Services 

ALVAN O. ZARATE, Ph. D., Assistant Director for 

International Statistics 

E. EARL BRYANT, Associate Director for Interview 

and Examination Statistics 

ROBERT L. QUAVE, Acting Associate Director for 

Management 

GAIL F. FISHER, Ph. D., Acting Associate Director 

for Program Planning, Evaluation, and Coordination 

MONROE G. SIRKEN, Ph. D., Associate Director for 

Research and Methodology 

PETER L. HURLEY, Associate Director for Vital and 

Health Care Statistics 

ALICE HAYWOOD, Information Officer 

Office of International Statistics 

ALVAN O. ZARATE, Ph. D., Director 
Acknowledgment 

This report was written in conjunction with the 

comparative study of health care systems in France 

and the United States, financed under Purchase Order 

No. PLD0443079 of the National Center of Health 

Statistics and by Centre de Recherche pour L’Etude 

et L’Observation des Conditions de Vie.a 

The work was made possible by the cooperation 

of colleagues in France and the United States, who 

supplied various published and unpublished documents, and who explained the terminology as well as 

some of the features of the health care systems of 

the two countries in personal communications. Special thanks are due to Robert Gibson and Barbara 

Cooper of the Health Care Financing Administration 

and to Dorothy Rice, Jack Feldman, Jim Baird, and 

Robert Thorner of the National Center for Health 

Statistics. 

I am grateful to Dr. Kerr White of the Rockefeller 

aThe Research Center for the Study and Observation of Conditions of 

Life, 

Foundation for reading and commenting on the draft 

report. 

I wish to address special thanks to Louise Russell 

of the Brookings Institution, who not only provided 

wise and useful comments during the writing of the 

report, but also took much of her time to review the 

translation from French into English. Her knowledge 

of economics of the health sector as well as her mastery 

of both languages guaranteed the accuracy of the 

changes she suggested. 

If, despite this expertise, errors of interpretation 

remain, they are the responsibility of the author. 

Documentary research and presentation of information were the responsibility of Lilian H-erisson, 

an intern at Centre de Recherche pour L’Etude et 

L’Observation des Conditions de Vie. The graphic 

artists were Martine Matthys and Janine %mrek, and 

Micheline Beliot typed the report. 

... 1!1 
1

2

3

4

5

6

Acknowledgment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii


Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Principal results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Chapter l. General featuresofthe United States and Frances. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Demography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4


Political organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5


Health caresector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


Production factors inthemedical sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6


State ofhealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6


Factors intheuse ofmedicalservices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8


Statistical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8


Chapter ll. Changes inmedicalcare expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Areacovered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Breakdown ofexpenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9


Timeperiods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


Methods usedtocompare changesin expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


Medical careexpenditures in1978. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


Level ofexpenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10


Structure ofexpenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12


Analysis ofchanges in health careexpenditures 1950to 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15


Growing role ofmedicalcare inthe economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15


Growth inexpenditures andprices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15


Role ofvarious factorsingrowthin medical careexpenditures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18


Differenttypes ofcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20


Distribution ofexpenditures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21


Changes inthefinancing ofmedical care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23


Chapter ill. Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26


Hospital sector production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26


Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26


Technical equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27


Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28


Hospital production andutilization ofhospital services, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28


Changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30


iv 
.

Hospital prices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Prices perdayand peradmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Structure ofhospital costsandcost index ofhospital care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Hospital expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Summary, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Study oftrends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Role offinancing method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Listofdetailed tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Appendix 

Estimates ofhospital expenditures in the United States and France by using acommon set ofdefinitions . . . . . . . . . . . . . . 

List of text figures 

10 Geography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

2, Crude mortality rate and infantmortality rate: United States and France, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . 

3. Life expectancy at birth, bysex:United States and France, 1950-77 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

4. Percapita medical care expenditure, bytype ofservices and goods: United States and France, 1978 . . . . . . . . . . . . . . 

5.	 Percent of medical care expeditures spent on hospital or nursing home care, medical services, and goods: United States 

and France, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

6. Percentofmedical care expenditures, by type offinancing, services, and goods: United States and France, 1976.. . . . . 

7. Medical care expenditure as a percent of gross national product: United States and France, 1950-78 . . . . . . . . . . . . . . 

8.	 Per capita medical care expenditures in relative values, by type of medical care, servcies, and goods: United States 

and France, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

9.	 Per capita medical care expenditures as a ratio in terms of nominal and relative values: United States and France, 

1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

10.	 Percent distribution of contributions of various factors to the increase of medical expenditures, by selected periods: 

France and United States, 1950-78. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

11. Percent distribution on contributions of various factors to the increase in per capita expenditures, by services and 

goods: France and United States, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

12.	 Percent distribution of medical care expenditures, by type of financing: United States and France, 1950, 1960, 1970, 

and 1978. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -

13.	 Percent of medical care expenditure, by third party payment and direct payment by consumer: United States and 

France, 1950-76 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

14. Average length of stay in general hospitals, by type of hospitals: France and United States, 1961 -78 . . . . . . . . . . . . . . 

15. Hospital costs, byselected factors: France and United States, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

16.	 Percent distribution of the contributions of various factors tothe increasesin per capita hospital expenditures: United 

States and France, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

17.	 Average annual rate of increase of per capita hospital expenditures, in relative value: France and United States, selected 

periods from 1950through 1978. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

18,	 Average annual rate of increase of per capita hospital expenditures, in constant. prices: France and United States, 

selected periods from 1950through 1978 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

19. Changes in per capita hospital expenditures, by selected factors: France and United States, 1950-78 . . . . . . . . . . . . . . 

List of text tables 

A, Percent distribution ofpopulation, by age: France and United States, 1976. . . . . . . . . . . . . . . . . . . . . . . . . . . ..-

B. Per capita gross national product (GNP) and average annual growth rates for current prices at the exchange rate of a 

given year and the constant 1978 prices at the 1978 exchange rate and ratio during 1950-78 and 1973-78: France 

and United States, 1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

c.	 Number of medical carepersonnel per 100,000 inhabitants: France and United States, 1976.... . . . . . . . . . . . . . . . 

D. Life expectancy at selected ages by sex and infant mortality rate: France and United States, 1976 . . . . . . . . . . . . . . . 

E. Percapita medical careexpenditures, bytypeof sewices and goods: France and United States, 1978 . . . . . . . . . . . . . 

F, Breakdown ofmedical expendituresby type of service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

G, Medical care expenditures as a percent of gross national product (GNP), per capita expenditures at current prices, 

andratio comparing the2countries: France and United States, 1950-78. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

H. Percent distribution and medical care expenditures, by type of services and goods: France and United States, 

1950-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................ 

30 

31 

32 

34 

34 

39 

39 

39 

41 

43 

44 

55 

4 

7 

7 

11 

13 

15 

18 

19 

20 

20 

22 

24 

25 

30 

32 

35 

36 

37 

38 

5 

5 

6 

7 

9 

10 

12 

14 

v 
---

J. 

K. 

L, 

M. 

N. 

o. 

P. 

Q. 

R. 

s. 

T. 

u. 

w. 

Y. 

z.


Percent distribution of medical care expenditures by type of financing, according to type of servcies and goods: 

France and United States, 1976 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Per capita medical care expenditures, by type of financing, services, and goods: France and United States, 1976 . . . . . . 

Percent distribution of contributions of various factors to the increase in medical expenditures by selected periods . . . . 

Average annual rate of increase during 1950-78 in nominal values of medical care expenditures per capita, by services 

andgoods: France and United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Percent distribution of medical expenditures, by types of financing: France and United States, 1950-76 . . . . . . . . . . 

Number of hospital beds per 1,000 population and average annual rates of increase during 1962-72, 1972-77, and 

1962-77, bytype of institution: France and United States, 1977 . . . . . . . . . . . . . . . . . . . .. . . . . . . ~. . . . . .; . . . 

Number of full-time equivalent staff per bed, ratio, and average rate of increase during 1962-72, 1972-77, and 1962-77, 

bytypeof institution: France and United States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Number of hospital admissions, ratio, and average annual rates of increase during 1962-72, 1972-77, and 1962-77, by 

typeofinstitution: France and United States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Number of hospital days, ratio, and average rates of increase during 1962-72, 1972-77, and 1962-77, by type of institution: France and United States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Average annual length of stay in hospitals, ratio, and average annual rates of increase during 1962-72, 1972-77, and 

1962-77, bytypeof institution: France and United States, 1977 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Cost per patient day in France and the United States, cost per admission, and ratios in general short-stay hospitals, 

with rates of increase during 1972-77: France and United States, 1972-77. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Average annual rate of increase in nominal and relative prices per patient day: France and United States, selected 

periods during 1950-77 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Average annual rate of increase in volume of production inputs per day: France and United States, selected periods 

1950-77 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Percent distribution of contribution of various factors to the growth of price per day, according to selected periods . . . 

Average annual rate of increase of various factors and percent distribution of their contributions to the increase in per 

capita hospital expenditures: France and United States, 1950-77. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 

Symbols 

Data not available 

. . . Category not applicable 

Quantity zero 

0.0 Quantity more than zero but lessthan 

0.05 

z Quantity more than zero but lessthan 

500 

* Figure does not meet standards of 

reliability or precision 

16 

17 

21 

21


25 

I 

27 

28 

29 

29 

29 

31 

32 

33 

33 

34 
Comparison of Health 

Expenditures in France and 

the United States 

by Simone Sandier, Director of Research of the Medical 

Economics Division, Centre de Recherche pour L@ude 

et L’Observation des Conditions de Vie 

Introduction 

A comparison of the health care systems in France 

and the United States through 19731 indicated that 

hospital services were the greatest part of total health 

care expenditures. Similarities in the growth patterns 

as well as differences in the structures of these systems 

and in the level of health care expenditures in the two 

countries were found. 

From 1950 to 1973, health care expenditures in 

France and the United States increased more rapidly 

than the gross national product did. Also, direct 

financing by patients was replaced progressively by 

third-party payments (i.e., public funds or private 

insurance), but direct financing and private insurance 

had a greater role in the United States than in France. 

During that time, health care expenditures were 

greater in the United States than in France, in absolute 

terms and in relation to overall economic indicators; 

however, the French spent more on pharmaceutical 

services and less on hospitalization than the Americans 

did. 

The purpose of this report is to update the earlier 

results by extending the study to 1978. The methods 

of analyses were (1) compiling avdilable, comparable 

statistical information on production, utilization, 

prices, and expenditures on health care; (2) comparing 

ratios such as density of personnel and per capita expenditures; and (3) determining the effects of various 

factors (e.g., the general economy, prices, and volume 

of health care expenditures) on the growth patterns of 

health care costs. 

This report has three chapters. The first chapter 

generally describes the demography, economy, and 

main features of each country’s health care system. 

The second chapter explains and analyzes the growth 

of health care expenditures in relation to economic 

indicators and corresponding changes by method of 

financing and category of health care service. The 

third chapter pertains to the hospital sector, the major 

component of health care expenditures. This chapter 

also discusses the growth of production means and its 

contribution to increasing hospital costs. 

The scope of this study did not allow analysis of 

physicians’ services and medical goods to the extent 

of other sectors; these areas should be the subjects of 

further study. 

1 
Principal results 

Several conclus~ns were drawn from the comparative analysis of health care expenditures in France 

and the United States to 1978. 

As noted in “A Comparison of the Health Care 

Systems of France and the United States,” 1primary 

differences between the two countries were evident 

in levels of expenditures, financing structures, and 

distribution of types of health care in given years. 

Nonetheless, the patterns of change in France and the 

United States shared many features, such as rapid 

growth rate of hospital expenditures, slow growth rate 

of pharmaceutical services, and increased role of the 

public sector in financing health care, which resulted 

in decreased costs paid directly by patients. 

The result of these changes was a growing similarity in health care expenditures between France and 

the United States. For example, per capita medical 

expenditures remained greater in the United States, 

but the gap between medical expenditures in the two 

countries was shrinking slowly because of the faster 

growth rate in France. Also, financing by third-party 

providers was greater in France, yet it was growing 

faster in the United States, and the proportion of direct payments by patients was declining more quickly 

in the United States than in France. 

Furthermore, the share of expenditures that may 

be attributed to pharmaceutical services was greater in 

France but was declining at a more rapid rate than 

in the United States; however, hospital expenditures 

were a greater percent of total costs in the United 

States but were increasing at a more rapid rate in 

France. 

The tendency to uniformity also was obvious in a 

detailed study of the operation of the hospital systems 

of each country. The United States served as a role 

model because: 

�	 Lengths of stay in short-term institutions were declining at a faster rate in France and were nearing 

values observed in the United States. 

�	 The number of personnel was increasing faster in 

France, although the staff-bed ratio was greater 

in the United States. 

�	 Increased care for the elderly in institutions, which 

is represented in the United States by increases in 

nursing home beds, was evidenced in France by 

introduction of medical care in homes for the 

elderly (hospices), which are slowly becoming the 

equivalent of convalescent homes. 
Trends 

In a study of change and growth patterns for 28 

years in two different countries, trends in rates of 

economic growth, overall inflation, and medical care 

price indexes must be considered. A study of the increases in expenditures in relative or constant price 

can refine the initial analyses based on nominal values. 

To varying degrees during 1973-1978, economic 

growth declined and the rate of inflation accelerated 

simultaneously in both countries. During this period, 

the share of medical expenditures (i.e., expenditures 

for personal health services) in the gross national 

product (GNP) rose, reaching 7.1 percent in France 

and 8.0 in the United States by 1978. As a result, 

governments in both countries showed increased concern for the growth in health care expenditures. In 

nominal terms, total medical expenditures increased 

more in both countries from 1973 to 1978 than they 

previously did; however, the progression in the volume 

of use slowed considerably in the United States and to 

a lesser degree in France. 

One result of the 1973-78 analysis was that “elasticities” computed against the GNP, which were useful 

in periods of economic growth parameters to predict 

growth in use of medical care (at current prices or in 

volume) lost meaning during economic stagnation 

or recession. In the short term, it may be concluded 

that growth in medical care costs is independent of 

the general economic climate; however, insufficient 

evidence was available to extrapolate this conclusion 

to the interim or long term. 

The role of financing methods in the growth of 

medical care appeared minor compared with distribution of care and technical progress. Comparison 

between the two countries indicated that if health 

insurance is not compulsory and is not the responsibility of the government, people rely on private insurance carriers for coverage during illness, thus limiting 

direct payments. However, the national health insur­

‘	 ante fund (Assurance Maladie) in France apparently 

averted the economic crisis in the health care field. In 

addition, relative prices of physicians’ and pharmaceutical services declined during 1973-78 as a result 

of medical services tariff negotiations conducted by 

health insurance fund offices. In the United States, 

overall medical care prices increased at an average 

annual rate of 1percent more than inflation; in France, 

relative prices declined at the rate of 0.7 percent per 

year. 

The low fees for ambulatory and pharmaceutical 

services specified by Assurance Maladie in France may 

explain lower pharmaceutical prices and why use of 

this service results in its higher percent of total medical 

expenditures in France. 

In both countries, it was hoped that controls on 

the diffusion of hospital equipment would help contain health care expenditures. Therefore, the American 

“certificate of need” and the French’ ‘carte sanitaire” 

(health map) were introduced. However, these measures were received reluctantly at the local level (where 

hospitals are vital to regional development and as 

sources of employment) and also were opposed by 

people who desired superior equipment near their 

residences. 

Life expectancy at birth, a common but imprecise 

indicator of health, increased during the past few 

years for men and women. In the United States, life 

expectancy is shorter than in France, but the increase 

in life expectancy has been more rapid. The relationship of variations in life expectancy to distribution of 

medical care and changes in lifestyles cannot be determined accurately. Furthermore, difficulty in determining the impact of health care services is compounded 

because morbidity can be both the reason and the 

result of care. Regional differences in each country 

are more pronounced than those observed between 

national averages in France and in the United States; 

therefore, study of these differences might clarify the 

impact of health care services. 

Increases in nominal prices and volume of health 

care in the two countries during 1950–78 each accounted for one-half of the increase in per capita 

medical care expenditures. Because of high inflation 

rates, the share that could be attributed to volume of 

health care declined to 27 percent in the United States 

and to 41 percent in France from 1973 to 1978. 

3 
Chapter L General features of 

the United States and France 

The United States comprises 9,405,352 square 

kilometers, and France, which is 17 times smaller, 

comprises 544,000 square kilometers (figure 1). 

Climatic ranges vary because of the differences in 

areas occupied. France is farther north (between the 

51st and 41st parallels) than the United States (between 

the 49th and 24th parallels); the southern region of the 

United States is only 33 degrees north of the tropic 

zone. The climate in France generally is mild; the 

40” 

climate in the United States is varied—cold in the 

North, semitropical in the South, dry in the Midwest, 

and wet in the Northwest. 

Demography 

Population density influences the ease of adequate 

distribution of health care and availability in immediate vicinities of target populations. In 1978, the United 

Figure 1. Geography 
I


States population was four times the population of 

France (217.3 compared with 53.2 million). With 

98 people per square kilometer, France ranks as a 

medium-population density country (50 to 150 people 

per square kilometer). With 23 people per square 

kilometer, the United States is considered to have a 

low-density population (fewer than 50 people per 

square kilometer). 

The French population is older than the population 

of the United States—France has a smaller proportion of people younger than 20 years of age and a 

larger proportion of people older than 65 years of 

age (table A). Medical care requirements are slightly 

greater in France, because morbidity usually increases 

exponentially with age. 

The population of the United States is growing 

faster (43 percent from 1950 to 1978) than that of 

France (27 percent). In both countries, the growth 

rate clearly declined during the past few years, mainly 

because of a decrease in the birth rate; the birth rate 

averages 15 per 1,000 population in the United States 

and 14 per 1,000 population in France. This decrease 

has contributed to the aging of the population—the 

proportion of pebple over 65 years of age increased 

between 1950 and 1977 from 11.4 percent to 13.8 percent in France, and from 8.1 percent to 10.9 percent 

in the United States. 

These changes quantitatively and qualitatively affect the need for medical care and, in both countries, 

planners increasingly are faced with the problem of 

distributing health care services to the elderly. 

Table A. Percent distribution of population, by age 

France and United States, 1976 

Age France United States 

Percent distribution 

All agea ,,.,,,, ,,,. .,...,... .............................. 100.0 100.0 

Under 20 years ....................................... 31.4 34.3 

20-64 years ............................................. 55.0 55.0 

65 years and over ................................... 13.6 10.7 

SOURCES: National Institute of Statistics and Economic Ressarch,Paria;and National 

Center for Health Statistics, Hyattsville, Md. 

Political organization 

Although both countries are Western democracies, 

three differences may affect health care systems: 

1.	 In the United States, States are largely autonomous 

and, therefore, the government is less central than 

it is in France, where regulations, organizations, 

and rates are uniform throughout the country. For 

this reason, the United States is a better testing 

ground for pilot projects on health care distribution or financing. 

2.	 The French economy is nationalized (e.g., electricity, gas, transportation, and communications 

are owned by the government). 

3.	 Industrial development and developments in the 

health care field2 in France depend to a great extent 

on technologies developed overseas. 

Economy 

Economic levels of two countries with different 

industrial and financial structures are difficult to 

compare because only general economic indicators, 

such as per capita GNP, are available. From this 

perspective, it appears that in 1950 the economic level 

of the United States was much higher than that of 

France. However, the difference between the two 

countries diminished considerably by 1978 when per 

capita GNP at current prices was only 7 percent higher 

in the United States than it was in France (it was 2.7 

times higher in 1950 [see table B]). This initial analysis 

is misleading to the extent that during 1950–78 inflation, which was growing at a greater rate in France 

than in the United States, contributed to the rapid 

growth of the French GNP. Thus the gap in GNP’s 1 

should not be viewed as indicating differences in 

standards of living until they are corrected by a purchasing power parity index in the two currencies. 

At constant prices, the per capita GNP from 1950 

to 1978 increased by a factor of 1.9 in the United 

States and by 3.3 in France. The gap between France 

and the United States is shrinking but cannot be 

quantified precisely. 

Tabla B, Per capita gross national product (GNP) and average annual growth rates for current prices at the exchange rate of a given year 

and the constant 1978 prices at the 1978 exchange rate and ratio during 1950-78 and 1973-78 France and Unitad States, 1950-78 

Per capita GNPin	 current prices at exchange rate Par capita GNP in constant 1978 prices at 1978 

of given year exchange rate 

Year United United United United France France States States States States — . 

Francs Dollars Dollars Frame Francs Dollars Dollars France 

1950 .,, ,.,.,, ,.,,,, ,..,............................ 2,341 671 1,641 2.74 12,076 2,675 4,989 1.87 

1978 ............................................... 39,945 8,857 9,451 1.07 39,945 8,857 9,451 1.07 

Average annual growth rates (percent) 

1950-78 ......................................... 10.7 4.4 4.4 2.3 

1973-78 ,,,,,!s,.,,, ,.!.,... ...,,..,,,,,..,.,,.. , 13.3 Iti ::; ::: 2.5 2.5 1.1 ::: 

NOTE: Exchange ratw 1 dollar= 4.5117 franca in 1978. 

5 
In both countries, the overall inflation rate accelerated and economic growth declined from 1973 to 

1978. This apparently did not result in a decline in the 

growth of health care expenditures, either in current 

or relative values; but it did emphasize the problem of 

health care financing. 

Health care sector 

Distribution of medical services was similar in 

both countries; for example, patients are free to consult physicians of their choice, physicians and other 

professionals usually are paid for each service rather 

than salaries, and public and private sectors coexist, 

especially in the hospital service area. 

On the other hand, financial coverage differed in 

the two countries. In France, 99 percent of the population is covered by a compulsory health insurance 

plan that reimburses hospital, medical, and pharmaceutical expenditures but leaves a percent (the “ticket 

moderateur” b) to be paid by the patient. 3 

In the United States, only the elderly and the 

economically disadvantaged receive Medicare and 

Medicaid benefits; others rely on private insurance. 

Medical coverage for hospitalization is better than for 

ambulatory services, but pharmaceutical services usually are not covered well. 

Production factors in the medical sector 

Like all economic sectors, production capacity of 

medical care depends on the volume, quality, and 

organization of production factors such as personnel, 

buildings, and equipment. 

In the health care field, manpower is the most 

important factor, as in most service production sectors; it accounts for the greatest share in expenditures 

(approximately 80 percent). In 1975, personnel employed in the health care sector constituted approximately 5 percent of the employed population in both 

countries. 

In all categories of personnel the density per 1,000 

population was greater in the United States than in 

France (table C). However, the gap between the two 

countries seemed to be narrowing for physicians and 

nursing staffs. From 1950 to 1976, the number of 

doctors per capita increased more rapidly in France— 

the annual increase in density averaged 1.1 percent in 

the United States and 3.6 percent in France. The large 

number of students in medical schools indicates that 

this trend is not likely to change in France before 

1985. Both countries have areas that are medically 

bThe ticket moderateur (paid by the patient) is approximately 25 percent 

of the ex~enditures for physicians’ services. 20 uercent of the hospitalization c&ts (with excep;io-ns), 30 percent of prescription drug exp~nses 

(60 percent for comfort drugs and Opercent for necessary drugs), and 40 

percent for services performed by auxiliary heafth workers (massage, 

speech therapists, and others). 

Table C. Number of medical care personnel per 100,000 inhabitants 

France and United States, 1976 

Medical care r.rersonnel France United States 

Physicians 

All active physicians .............................. 153.1 160.2 

All private physicians....................... 107.8 100.0 

Generalists practitioners ............ 64.8 21.4 (34.5)’ 

Specialists .................................. 43.0 78.6 (65.5)1 

Nurses 

All nurses............................................... 3S6.7 681.0 

Registered nurses ............................ 123.7 230.0 

Others .............................................. 263.0 451,0 

Dentists ....................................................... 50.0 52.0 

Pharmacies ................................................. 38.8 57.0 

I Swond ~omPutstion of den~itv of private physicians in the United Stetes includes, 

in the “generalists” category, “internal medicine physicians” who perform services 

comparable to those of French general practitioners. 

SOURCES Ministbre de la Sant6, Paris, and National Center for Health Statistics, 

Hyattaville, Md. 

underserved4 and planners encourage young physicians to move to these areas. 

The two countries have important differences in 

degrees of specialization and organization of medical 

offices. The range of specialties among physicians and 

dentists is much greater in the United States. The level 

of specialization also is much greater in the United 

States. In France, general practitioners account for 65 

percent of all private physicians. In the United States, 

general practitioners account for only 21 percent 

of all private physicians. If American internists are 

counted as general practitioners, the percent increases 

to only 34.5 percent of all private physicians. In addition, more auxiliary personnel are employed in medical and dental offices in the United States than in 

France. 

In both countries, health care policymakers must 

consider that in times of economic recession, growth 

in the health care field helps to alleviate unemployment; however, rapid increases in the number of personnel is incompatible with the goal of containing 

costs. 

State of health 

No single indicator may be used to compare the 

state of health of the French and American peoples, 

The effect that use of medical services has on health 

cannot be measured in either country because health 

depends on many factors, such as environment and 

living conditions. 5 

Mortality rates and life expectancy for various 

age groups are the factors most commonly analyzed 

in the health care field. These factors seem to indicate 

that the general state of health is slightly better in 

France (figures 2 and 3) than in the United States. 

The French also have longer life expectancy and less 

infant mortality (table D). 

Data in table D are national averages that disguise 

the pronounced differences by social class and region. 

6 
----

---------------

Table D. Life expectancy at aalected ages by sex and infant 

mortality rata France and United States, 1976 

Age France United States 

Life expectancy 

(in yeara) 

At birth: 

Infant mortality in France Men .................................................. 68,2 66.7 

Women ............................................ 77.2 76.1 

:\ -. +.+ 

20 years 

Men .................................................. 51.0 50.9 “-.-:-:-. _ 

Infant mortahty m Women ............................................ 56.6 57.8 

United Statea x. \ 40 years .-. -. Men .................................................. 32.5 32.7 

%.- Women ............................................ 38.3 38.7 

Cruda mortality in France -.. .\ 65 years ,\\~~$~*,??#mii!!*~,, ,,,,#%,%as8a8,,'l#,,,.",s%%$,8,,,,..%,,.%*<+,,,,,,,,,,,a,,,8<%8,",8< Men .................................................. 13.4 13.7 \ ----.--- ."!,,,,,,,, #l,,,j,,,.#,!ll! .-_-.~--- !#!#,,,,,,,,l,,,,,,,,,,,, 

Women ............................................ 17.4 17.7 

Crude mortality in United States 

Infant mortalii rate’ 

I t t , , I , , , , 1, , I , , , , 1, I Itr, Deatha at under 1 year of age 

1950 1955 1860 1865 1970 19751978 per 1,000 birtha ................................... 12.5 15.2 

Year I Corre~adinfant~o~s~~ rate fincludnginfsntsbornalive MO ded before they 

ware regiateradin civilboards). 

Figura 2. Crude mortality rate and infant mortality rate 

United States and France, 1950-78 

78 78 

Men Women r 

76 76 France 

74 74 “e Unitad States 

72 72 

.0” 

/

70 70 

Franca I 

68 68 

t 

66 ~.d” e“ 66 

t 

64 64 

1 

62 62 

t 

-rF

,0 ~ ,() ~ 

1950 1960 1965 1970 1977 1950 1960 1965 1970 1977 

Yaar Year 

Figure 3. Life expectancy at birth, by sex: United States and France, 1950-77 

7 
The difference in life expectancy was as much as 4 

years between the U.S. States and regions in France. 

In both countries, cardiovascular diseases and cancer are leading causes of death. 

Factors in the use of medical services 

The influence of demographic or socioeconomic 

factors on medical services use is similar in both countries.G’7 

�	 Rural populations use fewer medical services than 

urban groups do. 

c	 Income level is only a weak influence on total use 

of medical services, but it does imply different 

structures because individuals use more specialized 

and fewer inpatient hospital services.8 

� Age and sex (demographic variables) most influence level and growth of different types of health 

care services.6 

In France and the United States, the demographic 

groups that rank highest in use of medical services are 

infants and the elderly and, to a lesser extent, women 

in childbearing years. Women use more ambulatory 

services than men do, but they frequent hospitals less 

(except during childbearing years) and their lengths of 

stay are shorter. 

Despite the significant impact of age on the level 

and rate of growth of medical services use, changes 

in the age structure of the two populations (which is a 

slow phenomenon) were not and will not be important 

in the increase in average medical services use. From 

1950 to 1970, the French per capita growth in medical 

services use, due solely to changes in age structure, 

was less than 5 percent for all services. The growth 

in per capita volume of care received was 300 percent. 

However, these factors were not studied further because they did not explain the growing demand for 

services in any category. 

Use of medical services is concentrated in both 

countries—a small number of patients account for a 

large proportion of expenditures. For example, during 

9 months in 1978,3.3 percent of the French population 

received 50 percent of all medical services, and 10 

percent of the population received 72 percent of all 

medical services.9 

By comparison, in 1970 (the closest year for which 

comparable data are available) 5 percent of the U.S. 

population used the most services and accounted 

for 50 percent of the medical expenditures in 1 year; 

10 percent of all users accounted for 66 percent .10 

This aspect of medical expenditures has numerous 

repercussions on health care policies and must be 

considered in any decisionmaking process on collective health care financing, distribution of technology, 

or cost containment. 

Statistical data 

Comparison of the growth of health expenditures 

in France and the United States was based on statistical data gathered from several sources such as: 

�	 Statistics on economic accounts in the medical sector, which are compiled according to international 

rules for national accounts and have been compiled 

annually since 1929 in the United States and since 

1950 in France. (Particular attention was given 

to medical care expenditures—called “Personal 

Health Expenditures ‘‘ in the United States and 

“Final Medical Consumption” in France.) 

� Production, personnel, and equipment statistics. 

�	 Statistics on output measures and use of services 

(medical services produced and used). 

�	 Data and studies of the impact of demographic 

and socioeconomic factors on the use of medical 

care services (drawn from household surveys). 

�	 Studies of medical facilities (physicians’ offices 

and hospitals). 

In making these comparisons difficulties were 

encountered and problems varied. First, national differences in geographic, demographic, political, and 

economic factors were unrelated to health and medical structures and to specific social policies. Second, 

statistical data often were not based on similar concepts (area covered, definitions, nomenclatures, and 

units of measure); therefore, valid conclusions are 

difficult to determine. Third, a problem for which 

economic theory offers no solution, the comparison 

of parameters (equipment, salaries, and production) 

are calculated in monetary units that are not stable or 

comparable. Use of an iterative process of successive 

approximations is the only method by which to provide 

valid comparisons. 

I 
I 

Chapter Il. Changes in medical 

care expenditures 

This chapter presents a comparative analysis of 

the growth of medical care expenditures, personal 

health expenditures in the United States, 11and final 

medical consumption in France. 12 

General 

Area covered 

This analysis considered goods and services provided by qualified professionals and specialized establishments for prevention, diagnosis, and treatment of 

disease for which costs were paid directly by the beneficiary or by third-party providers. This study excluded 

medical services provided by private companies and 

schools, as well as costs of research, teaching, and 

preventive health care and administrative expenditures 

made by health insurance organizations. 

Homogeneity in definitions for total expenditures 

enabled valid comparisons between the United States 

and France. However, a detailed look at the types of 

services raised questions concerning the determination 

of the boundaries between services. 

�	 Hospitals—An accurate definition of hospitals was 

difficult because of gradual transitions from shortstay and long-stay hospitals, nursing homes, homes 

for the elderly (hospices), and retirement homes, in 

which medical care is available to varying degrees. 

�	 Expenditure computation—Methods of computing 

expenditures under various headings may cause an 

overlap in statistics relating to different categories 

of expenditures. 

Breakdown of expenditures 

The breakdown of medical expenditures by service 

category is shown in tables E and F. Services provided 

may be grouped into three aggregates: institutional 

care or hospitalization, medical services, and medical 

goods. 

National accounts also categorized health care 

expenditures by source of financing. In the United 

States, health care expenditures are delineated by 

direct payments; private insurance; and Federal, State, 

and local governments. In France, health care expenditures are shown by consumers, mutual insurance 

Table E. Per capita madical care expenditures, by type of services and goods France and United States, 1978 

France United States 

Type of service and goods United France Francs Dollars States Dollars Francs = 1(X7 = 100 

A, Hospital and nursing home care........................................................... 1,371.9 304.0 73 411.5 1,856.8 135 

1. Physicians'services.............................................................................. 414.4 91.8 58 158.0 713.2 172 

2. Dentists' services ................................................................................. 277.4 61.5 103 59.6 269.0 97 

3, Other medical sarvices ......................................................................... 186.7 41.3 215 19.2 86.4 46 

B = 1 + 2 + 3 Medical services.................................................................. 878.5 194.6 82 236.8 1,068.6 122 

4. Pharmaceuticals and small equipment ................................................. 542.0 120.1 177 67.7 305.4 56 

5. Eyeglassesand appliances................................................................... 48.9 10.8 62 17.4 78.5 160 

C = 4 + 5 Medical goods........................................................................... 590.9 130.9 154 85.1 383.9 65 

D. Otherl ................................................................................................... . . . . . . . . . 19.4 87.6 . . . 

T = A -I- B + C + D Parsonalmedical expenditures .................................. 2,841.6 629.8 83 752.9 3,397.2 119 

1Includesellotherservicesandgoods. 

NOTES Exchangeratw 1dollar= 4.5117 francsin 1978. Figures may not add to totals dueto rounding. 

9 
� 

� 

� 

� 

Table F. Breakdown of medical expenditures by type of service 

France United States 

Total, medical csre Total, medical care 

Hospitalization Institutional care 

Hospital care 

Nursing homes 

Total, medical services Total, professional services 

Physicians’ services Physicians’ services 

Services of auxiliary personnel Other professional services 

Laboratory services 

Spas 

Dental services Dental services 

Total, medical goods Total, medical goods 

Pharmaceuticals Pharmaceuticals 

Eyeglasses and appliances Eyeglasses and appliances 

companies, Assurance Maladie, and state and local 

governments. 

Time periods 

The comparison covered 1950-78 for all health care 

expenditures and for the three aggregates defined 

earlier (hospitalization, medical services, and medical 

goods); however, statistics for France were available 

in great detail only for 1960-78. 

To analyze changes accurately and associate them 

with factors such as rates of economic growth, inflation, and the introduction and diffusion of insurance 

systems, four periods of unequal length were studied— 

1950-60, 1960-70, 1970-73, and 1973-78. 

Methods used to compare changes in expenditures 

To consider differences in the United States and 

France by total populations, level and growth of economies, overall inflation rates, increases in prices of 

medical care, and variations in the dollar and French 

franc exchange rates, several approaches based on the 

study of different parameters were used. 

10 

Nominal value per capita expenditure (NV)—NV is 

expressed in a country’s currency at the prices of a 

given year or in the currency of another country 

using the average exchange rate in effect during the 

given year. 

Relative value per capita expenditure (R V)—RV is 

obtained by deflating the nominal value by the 

general price index (GPI) in each country. RV is 

expressed either in 1978 currency of each country 

or in the currency of another country at 1978 exchange rates. Increase in RV shows the increase in 

medical expenditures if the GPI had not increased. 

Nominalprice index for medical care (NPI)-lWI 

is established with a reference base year value of 

100 and shows the changes in price for a given 

type of service. 

Relative price index for medical care (RPJJ-RF’1 

is obtained by deflating the NPI by the GPI. RPI 

growth shows the price increase for services if 

the GPI had not increased. 

.	 Per capita volume of medical care (PC~—PCV 

is the value at constant prices and is obtained by 

deflating NV for a given category of service by the 

corresponding NPI. The volume of care reflects 

qualities and kinds of medical services provided. 

PCV indicates growth in medical expenditures if 

prices had not increased. 

The following relationships hold between these 

variables: 

NV= RVXGPI=PCV XNPI=PCVXRPIXGPI 

With these relationships, growth of medical care expenditures may be separated into components: price 

and volume or relative value and general price index. 

For additional clarification, the share of medical 

expenditures in the GNP is a ratio that indicates the 

share of medical care in the economy of the country. 

Medical care expenditures in 1978 

Level of expenditures 

Preliminary estimates for 1978 show total medical 

consumption was $168 billion in the United States 11 

and 151 billion francs 13($34 billion) in France. 

These expenditures were a greater percent of the 

GNP in the United States (8.0 percent) than in France 

(7. 1 percent), although 1978 per capita GNP was 6.8 

percent higher in the United States. 

Per capita’ personal medical care expenditures 

totalled $753 in the United States (20.0 percent more 

than in France); in France, per capita medical care 

expenditures were estimated to be 2,841 francs or 

$630 at the current exchange rate. 

The totals are the results of different expenditure 

patterns for different types of care in each country. 

The per capita expenditure is greater in the United 

States for hospitalization and medical services, but 

pharmaceutical expenditures are greater in France 

(table E and figure 4). 

Using the definitions and estimation methods 

established for each country, per capita hospital expenditures in the United States were $411, or 35 percent 

greater than in France, where they were estimated to 

be 1,372 francs ($304) (table G). Per capita expenditures for physicians’ services in France were estimated 

to be 414 francs ($92), which is 72 percent greater than 

expenditures in the United States ($158). Pharmaceutical expenditures in France were 542 francs ($120), or 

77 percent more than in the United States, where they 

were estimated to be $68. Expenditures for dental 

copulation figures are shown in table 3. 
800 ............ m. .

. “~~ UnitedStates ....... 

752.9. m France

700 

600 

500 

411.5 

300 

236.8 

200 

Eyeglasses and 

appli~ces 130.9 

100 

0 

All Hospital Medical Medical 

medical and nursing services goods 

home carel 

lEx~ludes nursing hOM@Sin F-x. 

Figure4. Percapita medical careexpenditure, bytypeof sewices and goods: United States and France, 1978 

11 
Tabla G. Medical care expenditures’ asa Percent ofgross national Product (GNP), PercaPita exPentituras at current Prices, 

andratio comDarincrthe2 countries France and United States, 1950-78 

Medical Total per capita national care expenditure r% capita expenditure: 

expenditures at current prices United Stetes 

Year as a percent of GNP compared to France 

France United States 

United Nominal Relative 

States Dollars Francs Dollars Francs value value 

1950 ................................................... 3.0 3.8 20.09 70.24 70.37 245.58 3.50 2.37 

1960 ................................................... 4.0 4.7 53.15 250.66 128.81 631.17 2.42 1.65 

1965 ................................................... 4.9 5.4 100.02 490,09 168.42 923.26 1.86 1.45 

5.2 5.5 111.91 548.48 205.22 1,007.63 1.83 1.41 

1967 ................................................... 5.2 5.8 122.93 604.81 227.07 1,117.18 1.85 1.41 

1968 ................................................... 5.2 5.9 129.54 641.23 252.32 1,248.98 1.95 1.49 

1969 ................................................... 5.5 6.2 147.98 768.00 260.63 1,456.47 1.90 1.40 

1970 ................................................... 5.7 6.7 157.81 872.40 315.25 1,708.66 2.00 1.37 

1971 ,.,,............................................... 5,8 6!8 179.02 992.57 342.52 1,667.29 1.91 1.32 

1972 ................................................... 5.9 6.8 221.40 1,116.66 376.14 1;685.75 1.70 1.33 

1973 ................................................... 5.9 6.8 281.99 1,269.38 413.53 1,640.21 1.46 1.30 

1974 ................................................... 6.1 7.1 309.56 1,487.41 467.72 2,254.41 1.51 1.28 

1975 ................................................m.. 6.8 7.6 429.45 1,644.66 534.82 2,284.38 1.24 1.21 

1976 ................................................... 6.8 7.8 447.82 2,148.95 602.45 2,873.69 1.34 1.21 

1977 ................................................... 6.8 7.9 486.96 2,409.89 674.46 3,311.60 1.38 1.25 

1978 ................................................... 7.1 8.0 629.64 2,641.64 752.98 3,384.84 1.20 1.20 

lparwna[ halthcar5eXPen~t”~eSintheU nitsdStatSS. Finaimsdicelconsumptiorrin France. 

Fiance 

NOTE Exchange ratel dollar =4.5117 francs in 1978. 

care were approximately equal in both countries— 

$60 in the United States and 277 francs ($61) in France. 

These figures must be interpreted carefully because 

medical care, covered by a single heading, was not 

identical for both countries; available data did not lead 

to equally accurate estimates in all service categories; 

and the activities of various producers of services differed between France and the United States. Examples 

of these problems are described below. 

Services for ambulatory patients provided in hospitals by staff physicians were included in “hospitalization” for the United States but in’ ‘physicians” for 

France. Inpatient care by private physicians was included as part of physicians’ services for the United 

States but was included in hospitalization for France 

(see appendix). 

Medical offices in the United States employ more 

personnel and offer more services than those in France 

do. Therefore, part of the expenditure that corresponds to “assistants” jobs or “laboratory services” 

in France was classified under physicians’ services in 

the United States. Hence, a study of “medical services” (excluding dentists) reduced the margin between 

the United States and France. 

Pharmacy expenditures were covered only partially by third-party providers (public or private) in 

the United States. Estimates were difficult to make 

because they apparently underestimated actual expenditures slightly. 14 

United States expenditures were re-estimated using, 

when possible, same definitions and classification of 

services used for France. By these estimates, 1978 total 

expenditures for institutional care were $441 in the 

United States (45 percent more than in France) and 

expenditures for physicians’ services to ambulatory 

patients were $128 (or 39 percent more than in France). 

Differences in levels of expenditures are caused by 

differences in levels of service utilization and price 

levels. A greater expenditure in one country may result 

from higher prices, greater use, or both of these factors 

(see chapter III). 

Because pharmaceutical prices are much greater in 

the United States than in France, 14the greater level of 

expenditures in France indicates greater utilization 

of pharmaceutical products than in the United States. 

Structure of expenditures 

The distribution of medical expenditures by service 

category (figure 5 and table H) differs in the two 

countries, in that (1) a greater proportion is spent on 

hospitalization in the United States (54.7 percent)d 

than in France (48.3 percent), (2) a greater proportion 

is spent on medical goods in France (20.8 percent) 

than in the United States (11.3 percent), and (3) expenditures for medical services are similar in both 

countries (31.4 percent in France and 30.9 percent ein 

the United States). 

Organization of medical services financing differs 

between France and the United States. Compulsory 

health insurance (Assurance Maladie) covered 99 percent of the French population in 1978. In the United 

States, Medicare and Medicaid are the only publicly 

dThiS figure increases to 58.6 percent if physicians’ fees are included and 

outpatient care is excluded. 

eThis figure decreases to 27.6 percent if inpatient care is excluded and 

outpatient care is included. 

12 
60 — 

D United States 

Hospital and nursing home carel 

~ France 

.- . 51.6 43.4 

50 

40.8 

40 37.7 Medical services 

36.0 

30 

20 

10 

o— 

1950 1960 1970 1973 1978 1950 1960 1970 1973 1978 

Year Year 

30 29.1 29.0 

27.1 

Medical goods 

20.8 

20 

g 

c1 

s

L 

10 

0 [ 

1950 1960 1970 1973 1978 

Year 

1 ~xclude~ nursing homes in France. 

Figure 5. Percent of medical cara expenditures spent on hospital or nursing home care, medical services, and goods: 

United States and France, 1950-78 

funded insurance programs available. Medicare covers 

only people 65 years of age and older; Medicaid covers 

only the economically disadvantaged. For the balance 

oft he U.S, population, individuals or their employers 

purchase insurance from private carriers. 

These differences and the differences in levels of 

reimbursement are indicated in the structures of medical care financing (figure 6 and tables J and K). 

In 1976, the proportion of public sector funds was 

much greater in France, where 71.0 percent of the 

expenditures were covered by Assurance Maladie, and 

3.2 percent of the expenditures were paid by national 

and regional public funds. In the United States, Federal, State, and local governments were responsible 

for only 39.1 percent of all medical expenditures. 

The proportion covered by private insurance in 

13 
---

Table H. Percent distribution and medical care expenditures, by type of services and goods France and United States, 1950-78 

Total 

medical 

Year and All Hospital sewices Other Total Pharmacy Eyeglasses 

and medical for Physicians’ Dentists medical medical and and Other2 care nursing ambulatory services small country home expenditures ----, patients services goods equipment appliances 

,.”, --a-


1950: 

United States .......... 

France ..................... 

1960: 

United States .......... 

France..................... 

1970 

United States .......... 

France...,...,...,, ........ 

1971: 

United States .......... 

France..................... 

1972 

United States .......... 

France..................... 

1973 

United States .......... 

France ..................... 

1974 

United States .......... 

France ..................... 

1975 

United States .......... 

France., ................... 

1976: 

United States .......... 

France ..................... 

1977: 

United States .......... 

France ..................... 

1978 

United States .......... 

France ..................... 

-. 

nd home 

care 

100.00 37.10 37.70 25.24 8.82 3.64 20.36 15.86 4.50 4.83 

100.00 38.30 32.80 . . . . . . . . . 28.90 . . . . . . . . . 

100.00 40.64 35,99 24.00 8.35 3.64 18.28 15.44 2.84 4.89 

100.00 36.40 34.50 19.10 11.10 4.30 29.10 26.44 2,66 ..-

100.00 49.41 31.49 21.83 7.23 2.43 15.98 12.79 3.19 3.12 

100.00 38.70 32.30 16.50 9.85 5.95 29.00 27.09 1.91 . . . 

100.00 50.47 31.36 22.07 7.03 2.26 14.86 12.04 2.82 3.31 

100.00 39.44 32.00 16.21 10.40 5.39 28.56 26.77 1.79 . . . 

100.00 51.49 30.75 21.44 7.05 2.26 14.47 11.70 2.77 3.29 

100.00 39.84 32.19 16.11 10.34 5.74 27.87 26.14 1.73 ..-

100.00 51.62 31.17 21.56 7.38 2.23 14.16 11.36 2.80 3.05 

100.00 39.88 32.99 16.44 10.01 6.54 27,13 25.49 1.64 . . . 

100.00 52.75 30.57 21.06 7.30 2.21 13.62 10.84 2.68 3.06 

100.00 41.44 32.06 15.90 10.15 6.01 26.50 24.75 1.75 

100.00 53.33 30.78 21.45 7.08 2.25 12.71 10.15 2.56 3.18 

100.00 43,27 31.35 15.56 9.84 5.95 25.38 23.52 1.86 ..-

100.00 53.93 31.01 20.93 7.66 2.42 12.11 9.69 2.42 2.95 

100.00 46.67 30.68 15.38 9.39 5.91 22.65 20.aa 1.77 . . . 

100.00 54.50 31.24 20.95 7.81 2.48 11.57 9.26 2.31 2.69 

100.00 48.34 30.83 14.87 9.94 6.02 20.83 19.12 1.71 ..-

100.00 54.66 31.46 20.99 7.92 2.55 11.30 8.99 2.31 2.58 

100.00 48.30 30.90 14.67 9.69 6.54 20.80 19.04 1.76 ..-

‘Excludes nursing homesin France. 

21ncludesall other goods. 

NOTE: F@resmaynotaddto totalsdu etorounding. 

the United States was greater (29.2 percent) than the 

proportion covered by mutual insurance in France 

(3.8 percent); total direct payments by patients also 

were greater in the United States (31.7 percent) than 

in France (22 percent). 

These differences show that if health insurance is 

not compulsory and is not the responsibility of the 

public sector, people tend to rely on private carriers 

to cover illness and to limit direct payments. 

Hospitalization, the least often needed and most 

costly type of care, accounted for the lowest proportion 

of direct payments by consumers in both countries. In 

France, 6.8 percent of direct payments were for hospitalization; in the United States, 12.6 percent of direct 

payments were for hospitalization—6.8 percent for 

hospitals and 43.1 percent for nursing homes. Dental 

services, which are optional services, account for more 

direct payments than other services in both countries— 

60.2 percent in France and 76.5 percent in the United 

States (table J). 

14 

Private insurance in the United States financed a 

large proportion of physicians’ services in 1976 (39.6 

percent). Direct payments by consumers for physicians’ services were only slightly greater in the United 

States (34.9 percent) than in France (28.7 percent); 

however, public financing of physicians’ services was 

much less common in the United States (25.5 percent) 

than in France (64.9 percent). This clearly demonstrates the reliance of the U.S. population on private 

insurance in lieu of compulsory public insurance. 

Pharmaceutical expenditures in 1976 did not constitute a large portion of medical service expenditures 

but were distributed among a great number of patients. 

Private insurance provided only limited funding for 

pharmaceutical expenditures, and the financing structures differed between the countries. In France, 35.2 

percent of pharmaceutical costs were direct payments 

by consumers; in the United States, 83.9 percent of 

the costs were direct payments by consumers. The 

public sector financed 58,2 percent of the expenditures 
- UniteclStates 

D France 

100 

92.2 

80 [ N 65.4 

au


74.2 t m 

46.8 II 

E 

40 1- 1

39.IN 

“ Consumers Private Public Consumers Private Pubuc LolInsumers Private Public Consumers Private 

insurance sector insurance sector insurance sector insurance sector 

All care, services, and goods Hospital and nursing Medical services Medical goods 

home carel 

1Excludes nursing homes in France. 

. 

12.6 . . 

10 – 5.8 . . 

s>. 

<< 

31.7 32.5 33.2 

30 – 28.2 

20.0 ‘ 

20 – ~~ 

n L d

\ 

H_ -

Figure 6. Percent of medical care expenditures, by type of financing, services, and goods: United States and France, 1976 

in France but only 8.9 percent in the United States. 

Public financing of pharmaceutical expenditures may 

explain the greater level of pharmaceutical expenditures in France. 

Analysis of changes in health care 

expenditures 1950 to 1978 

Growing role of medical care in the economy 

In France, as in the United States and several other 

countries, the role of medical care in the economy 

grew from 1950 to 1978. Analysis of the changes (figure 7) revealed several distinct periods: 

�	 From 1950 to 1960, health care expenditures in 

the GNP increased at similar rates in the two 

countries, from 3.8 to 4.7 percent in the United 

States and from 3.0 to 4.0 percent in France 

(table G). 

�	 From 1960 to 1965, growth was more rapid in 

France, probabIy because of extension of health 

insurance and improvement in financial coverage 

for medical expenses. 

s	 From 1966 to 1970, health care expenditures in 

the GNP increased more rapidly in the United 

Statesthan in Franceas a resuItofthe introduction 

of Medicare and Medicaid. 

c	 After stagnation in the medical ex~enditure to 

GNP ratio from 1970to 1973 (a perio~ of sustained 

economic development), growth began again in 

both countries from 1973to 1978. Economic development slowed and the proportion of medical 

expenditures in the GNP increased from 6.8 percent to 8.0 percent in the United States and from 

5.9 percent to 7.1 percent in France. Increases 

were evident in the percent the GNP spent on 

medical expenditures in 1975, a year characterized 

in the United States and France by a decline in the 

GNP. 

These developments support the hypothesis that medical consumption rates change independently of the 

general economy. 

Growth in expenditures and prices 

Although rapid in both countries, the growth in 

per capita medical expenditures at current price levels 

was characterized from 1950 to 1978 by a greater 

average yearly increase rate in France (14.1 percent) 

than in the United States (8.8 percent) (table G). However, overall inflation rates were greater in France, 

with an average yearly increase in the GPI of 6.0 

percent from 1950 to 1978. This index rose an average 

of 3,6 percent annuallyin the United States. 

If adjustments are made for inflation in each 

15 
Table J. Percent distribution of medical care expenditures by type of financing, according to type of services and goods 

France and United States, 1976 

France 

Type of financing 

Care, services, Rivate Public and goods All Direct Mutual National and Health financing Total payment insurance Total regional insurance 

by consumer and other governments fund 

Percent distribution 

1. Hospital care......................................... 100.0 7.8 6.8 1.0 92.2 5.2 87.0 

2. Physicians............................................. 100.0 35.1 28.7 6.4 64.9 63.5 

3. Dentists ................................................ 100.0 64.2 60.2 4.0 35.8 E 35.5 

4. Other medical services ......................... 100.0 19,0 12.3 6.7 81.0 1.9 79.1 

5. Pharmaceuticalsand small equipment... 100.0 41.8 35.2 6.6 58.2 2.1 56.1 

6. Eyeglassesand appliances ................... 100,0 60.0 54.4 5.6 40.0 40.0 

Total (2+ 3 + 4 + 5 + 6)..., ...................... 100.0 41.4 35.3 6.1 58.6 1.5 57.1 

Total, medical care .................................... 100.0 25.8 22.0 3.8 74.2 3.2 71.0 

United States 

Type of financing ‘ 

Care, sewices, Rivate Public 

and goods All Direct F7ivate State and financing Total payment insurance Total Federal local 

by consumer and other governments 

1. Hospital care......................................... 100.0 45.2 

2. Nursing home care ............................... 100.0 44.5 

Total (1 +2) .............................................. 100.0 45.1 

3. Physicians'services.............................. 100.0 74.5 

4. Dentists ................................................ 100.0 95.2 

5. Other medical services ......................... 100.0 79.5 

6. Pharmaceuticalsand small equipment... 100.0 91.1 

7. Eyeglassesand appliances ................... 100.0 91.9 

Total (3+ 4 + 5 + 6 +7) .......................... 100.0 83.1 

Otherl ....................................................... 100.0 25.7 

Total, medical care .................................... 100.0 60.9 

1ln~l”des al! other services and goods. 

NOTE Figures may not add to totals due to rounding. 

country by deflating medical expenditures by the GPI 

to create a new expenditure series or RV, the difference 

in rates of growth is reduced, but not eliminated. The 

average rate of growth in this adjusted expenditure 

series was 5.0 percent per year in the United States 

from 1950 to 1978 and 7.6 percent per year in France 

(figure 8). 

The difference in levels of per capita medical care 

expenditures in the two countries declined during 

1950-78 by either measure of expenditure. Americans 

spent an average of 3.5 times more than the French on 

medical care in 1950 (in current prices); by 1978, 

Americans spent only 20 percent more than the French 

(in current prices). 

The reduction was smaller but pronounced in per 

capita RV’S of expenditures; the United States to 

France ratio declined from 2.4 in 1950 to 1.2 in 1978. 

Increasing similarity of medical expenditures in 

the two countries was marked between 1950 and 1960 

and continued, although more slowly between 1960and 

16 

Percent distribution 

6.8 38.4 54.8 39.9 14.9 

43.1 1.4 55.4 31.5 23.9 

12.6 32.5 54.9 38.6 16.3 

34.9 39.6 25.5 18.5 7.0 

76.5 18.7 4.8 2.8 2.0 

55.1 24.4 20.5 14.5 6.0 

83.9 7.2 8.9 4.6 4.3 

91.2 0.7 8.1 6.3 1.8 

57.6 25.5 16.9 11,7 5.2 

25.7 74.3 54.6 19.7 

31.7 29.2 39.1 27.5 11.6 

1974; by contrast, the difference in PV’S from 1975 

to 1978 remained stable (figure 9). 

Average rates of growth in medical expenditures 

for the 1950-78 period corresponded to different rates 

of increase for different subperiods (figure 10). 

The growth in the value of expenditures at current 

prices accelerated from 1973 to 1978 in both countries. 

During these 5 years, per capita medical expenditures 

in the United States increased by a yearly average of 

12.7 percent compared with 9.4 percent from 1960 

to 1970, In France, the rate of growth was faster— 17.5 

percent per year from 1973 to 1978 compared with 

13.3 percent from 1960 to 1970. To avoid misleading 

conclusions, however, these high rates must be adjusted for general inflation. Therefore, the RV of per 

capita medical expenditures increased at a slower rate 

during the period of economic crisis than before it, at 

an average yearly rate from 1973 to 1978 of 4.4 percent in the United States and 6.1 percent in France 

(figure 10). 
Table K, Per capita medical care expenditures, by type of financing, services, and goods France and United Statesr 1976 

Care, servicas, 

and goods 

All medical 

expenditures 

per capita .............. 

Hospital care ........... 

Physicians ............... 

Dentists.,.,,,,.,,..., ..... 

Other medical 

services ................ 

Pharmaceuticals 

and smsll 

equipment ............ 

Eyeglasses and 

appliances ............ 

Total ........................ 

Care, services, 

and goods 

All medical 

expenditures 

per capita .............. 

Hospital care ........... 

Nursing home 

care ...................... 

Total ........................ 

Physicians ............... 

Dentists ................... 

Other medical 

serwces ................ 

Pharmaceuticals 

and small 

equipment ............ 

Eyeglasses and 

appliances ............ 

Total ........................ 

Otherl ...................... 

France 

Type of financing 

F?ivate Public 

All Direct Mutual National and Health financing Total payment insurance Total regional insurance 

by consumer and other governments fund 

Francs Dollars Francs Dollars Francs Dollars Francs Dollars Francs Dollars Francs Dollars Francs Dollars 

2,144.47 448.68 551.45 115.38 471.53 98.65 79.92 16.72 1,593.02 333.30 68,70 14.37 1,525.32 319.13 

1,001.42 209.52 78.46 16.42 68.06 14.24 10.40 2.18 922.96 193.10 51.60 10.80 871.36 182.31 

330.77 69.20 116.05 24.28 94.99 19.87 21.06 4.41 214.72 44.92 4.50 0.94 210.22 43.98 

189.83 39.72 121.82 25.49 114.31 23.92 7.51 1.57 68.01 14.23 0.59 0.12 67.42 14.11 

140.51 29.40 26.69 5.58 17.22 3.60 9.47 1.98 113.82 23.82 2.65 0.55 112.17 23.47 

444.22 92.94 185.80 38.88 156.42 32.73 29.38 6.15 258.42 54.07 9.36 1.96 249.06 52.11 

37.72 7.89 22.63 4.73 20.53 4.30 2.10 0.44 15.09 3.16 - - 15.09 3.16 

1,143.05 239.15 472.99 98.97 403.47 84.42 69.52 14.55 670,06 140.19 17.10 3.57 653.96 136.82 

United States 

Type of financing 

Private Public 

All Direct Private State and financing Total payment insurance Total Faderal local 

by consumer and other governments 

Francs Dollars Francs Dollars Francs Dollars Francs Dollars Francs Dollars Francs Dollars Francs Dollars 

2,879.57 602,47 1,754.57 367.20 912.47 190.91 842.60 176.29 1,124.50 235.27 790.74 165.44 333.76 69.83 

1,303.35 272.69 589.23 123.28 89.04 18.63 500.19 104.65 714.12 149.41 520.40 108.88 193.72 40.53 

249.64 52.23 111.32 23.29 107.78 22.55 3.54 0.74 138.32 28.94 78.58 16.44 59.75 12.50 

1,552.99 324.92 700.55 146.57 196.82 41.18 503.72 105.39 852.44 178.35 598.98 125.32 253.46 53.03 

602.76 126.11 448.76 93.68 210.40 44.02 238.36 49.87 154.00 32.22 112.13 23.45 41.92 8.77 

220.82 46.20 210.30 44.00 169.01 35.36 41.30 8.64 10.52 2.20 6.21 1.30 4.30 0.90 

69.78 14.60 55.44 11.60 38.43 8.IM 17.02 3.56 14.34 3.00 10.08 2.11 4.25 0.68 

279.13 58.40 254.23 53.19 234.20 49.00 20.03 4.19 24.90 5.21 12.90 2.70 12.00 2.51 

69.78 14.60 64.14 13.42 63.62 13.31 0.53 0.11 5.64 1.18 4.40 0.92 1.24 0.26 

1,242.27 259.91 1,032.87 216.10 715.65 149.73 317.22 66.37 209.39 43.81 145.68 30.48 63.71 13.33 

64.31 17.64 21.65 4.53 - - 21.65 4.53 62.66 13.11 46.08 9.64 16.59 3.47 

‘Includes all other services.


NOTES: Exchangerata 1 dollar= 4.78 francs in 1976. Figures may not add to totals due to rounding.


These increases are results of growth in use of 

medical care (in quantity and service) and in prices 

(whether judged by RV or current prices) for different 

types of medical services and goods, which were not 

uniform during the entire period. 

The volume of medical care, which describes 

growth in medical care expenditures if medical prices 

remained constant, increased at an average annual 

rate of 4.0 percent in the United States from 1950 to 

1978, less rapidly than the rate in France (7.2 percent). 

Per capita medical care consumption increased 

most from 1960 to 1970 in both countries, at an 

annual rate of 8.3 percent in France and 5.2 percent 

in the United States. However, from 1973 to 1978, 

growth increased; this was more marked in the United 

States (3.3 percent per year) than in France (6.9 percent). 

No reasons are obvious for this decline; however, 

two hypotheses are presented. First, declining growth 

was normal after improvements in social insurance 
8 

United States 

7 

6 

5 

E 

;4 

2 “,””,!$$ *... *,,,. ,#!+ ,@’” 3 

2 

1 

0 — I I I 1 1 I I 

18!3) 1955 1880 1885 1970 1975 1978 

Year 

Figure 7. Medical cara expenditure as a percent of gross national 

product: United States and France, 1950-78 

systems (from 1960 to 1970 in France and from 1966 

to 1970 in the United States), which permitted previously unmet needs for care to be attained. 

Second, despite the demand for care, which generally is independent of overall economic conditions, 

the economic crisis during 1973-78 contributed to the 

decline in the demand for care and, consequently, 

in the growth of medical care providers. Growth of 

medical care providers may have been restrained 

by the diffusion of technical progress, a significant 

force behind development of health care use. This 

may have had less effect in France because of collective financing. 

The price index for medical caref increased faster 

in France than in the United States, with average 

annual growth rates from 1950 to 1978 of 4.7 percent 

in the United States and 6.4 percent in France. However, in both countries, increases in medical care prices 

were close to the increases in the consumer price index 

(CPI). The RPIg for medical care averaged an annual 

increase of 1.0 percent in the United States and 0.4 

percent in France during the same period. For this 

measure as for the others, the situation differs 

in different subperiods. In the United States, the 

Economic Stabilization Program, which lasted from 

f~15 index is an implicit price index computed from price increases in 

each service category. 

gMedical care price index divided by the GPI. 

18 

August 1971 to April 1974, explains, to a great extent, 

the 0.5-percent decline per year in relative prices from 

1970 to 1973 and the rise from 1973 to 1978, In 

France, the decline in relative prices for medical care 

( –0.9 percent per year from 1970 to 1973 and –0.7 

percent from 1973 to 1978) was a direct result of 

the hard negotiations over fees between professionals 

and health insurance officials, particularly in the 

cases of medical and pharmaceutical services. 

Role of various factors in growth in medical care 

expenditures 

As a followup to the description of the changes 

in the factors that caused medical expenditures to 

increase, the influence of each factor (general price 

index, relative prices for medical care deflated by the 

GPI, volume of care, and medical spending of relative 

value [medical care in current prices] deflated by the 

GPI) was quantified (figure 10). 

The method used was: 

if a variable X. is the product of variables ~, 

i=s, r.. n 

let 

~i = the increase in variable Xi 

~ = the contribution of variable Xi to the growth 

of variable X., 

then 

X.= IIi~ 

(1+ CYo)= 11(1+ ~i) 

10g (1+ O!i) 

log (1+ Cto)= ~og (1+ ‘i) G = log (1+ CYo) 

In both countries during 1950-78, increases in 

prices and volume each accounted for approximately 

half of the per capita increase in medical expenditures 

(table L). However, volume of expenditures was more 

important in France (53 percent compared with 47 

percent in the United States), and price of expenditures 

was more important in the United States. Although 

inflation increased more rapidly in France than the 

United States, the contribution of the GPI was approximately the same in both countries (42 percent in the 

United States and 44 percent in France). The proportion attributable to relative prices (i.e., the medical 

care price index divided by the GPI, which measures 

the extent that the medical care prices rose faster [or 

slower]) is much lower in France (3 percent compared 

with 11 percent in the United States). 

This situation differed according to subperiods; 

the weight of prices increases in both countries when 
---

---

H“ 

J
 /

0’ 

# ,0 

.~” 

/“

0“”’ /./ 

All care 

0“ ./. ... 

Hoepital and “ Medical services.....”””” 

nursing home....”””: .....”... 

carel ...”” ““ ... 

.....” # 

...”..”” .. 

,,~ lo~ 

1950 1955 1960 1965 1970 1978 1950 1955 1960 1965 1970 1978 

Year 

800 r 

All care 

-.#- /.. ,,,, ,,/ 

/

4,’ 

/ +-a------­

..f 

,,;/ 

./” .Z. 

.HT-J ~--_---

~= ,,/’’Madical goods 

,/ 

i 

/’ 

10 I 111111111111111111] 

1950 1955 1960 1965 1970 1978 

Year 

lExcludesnursinghomesinFrance. 

Year 

All medical care, United States 

— All medical care, France

IIHIIWI,I Hospital care, United States 

. . . . . . . . . . Hospital care, France 

.— Medical services, United States 

. . ...”.. Medical services, France 

.. —-.. Medical goads, United States 

‘-- Medkalgoods, France 

Figure8, Percapita mdicalcare expenditures inrelative values, bytypeof medical care, sewices, and goods: United States and France, 1950-78 

19 
the rate of general inflation rises. For example, from 

1960 to 1970, the increase in expenditures attributable 

to the volume of care peaked at approximately 60 

percent, then it declined to 27 percent in the United 

Similarly, from 1960 to 1970, the proportion of 

the GPI was approximately 30 percent; from 1973 to 

1978, the GPI accounted for almost 65 percent of the 

total increase in expenditures. The weight of relative 

prices for medical care remained low—in France, the 

weight was negative from 1970 to 1978. In the absence 

of growth in other factors, the decline in medical care 

prices in relation to the GPI in France would have 

contributed to a decrease in per capita medical expenditures. However, this reasoning does not account 

for compatibility among the growth rates of the 

various factors; for example, the slight increase in 

relative prices for care is not independent of the acceleration of the general inflation rates. 

This analysis suggests possibilities to moderate 

growth of expenditures and indicates the limits of 

eventual policies. In particular, it emphasizes the role 

of overall inflation and its mechanical effects on the 

growth in medical expenditures. 

Different types of care 

Patterns of change.—The patterns of change and 

growth described for total medical expenditures resulted from different patterns for different types 

Nominal value: 

U Percapita Mativevalw 

Ezzl General price index 

R Nominal medical care price index 

Per capita volume m 17.5 

12.8 13.1 12.7 6.1 

9.5 

I 

66 

I -1

8.5 r-u 

States from 1973 to 1978 and to 41 percent 

during the same period. 

‘r


,~ Iw 1965 1970 

Year 

Ficsure 9. Per ca~ita medical care ex~enditures as a ratio 

;ominal and relative values: Unit& States and France, 

14.1 14.0 1 I 

8.8 7.6 r-l -1 7.9 

6.2 

in France 

1975 1978 

in terms of 

1950-78 

I


I 

9.4 

d 6.4 

France France 

1950-78 1950-60 

France France 

France 

1960-70 1970-73 1973-78 

NOTE: Figures shown on the chart indicate average annual increase rates (percent) of the various fastors. 

Figure 10. Percent distribution of contributions of various factors to the increase of medical expenditures by selected periods: 

France and United States, 1950-78 

20 
Table L. Percent distribution of contributions of various factors to the increase in medical expenditures bv selected oeriods 

Total Hospital and Medical services Medical goods medical care nursing home care~ 

France Unitad States France United States France United States France United States 

Selected 

period 

1950-78 

1950-80 

1960-70 

1970-73 

1973-78 

Factors 

Nominal value ............. 

General price index ..... 

Relative price .............. 

Volume ........................ 

Nominal value ............. 

General price index ..... 

Relative price .............. 

Volume ........................ 

Nominal value ............. 

General price index ..... 

Relative price .............. 

Volume ........................ 

Nominal value ............. 

General price index ..... 

Relative price .............. 

Volume ........................ 

Nominal value ............. 

General price index ..... 

Relative price .............. 

Volume ........................ 

Percent distribution 

100 100 100 100 100 

36 45 45 48 55 

18 13 15 -28 -25 

46 42 40 80 70 

100 100 100 100 100 

30 41 38 42 40 

32 28 16 -21 -5 

38 31 46 79 65 

100 100 100 100 100 

25 34 35 33 36 

19 10 18 -23 -28 

56 56 47 90 92 

100 100 100 100 100 

44 46 52 61 90 

2 7 -2 -57 -59 

54 47 50 96 69 

100 100 100 100 100 

59 68 63 94 102 

11 -6 16 -44 -35 

30 38 21 50 33 

100 100 100 

44 42 43 

3 11 9 

53 47 48 

100 100 100 

44 34 44 

9 21 5 

47 44 51 

100 100 100 

32 30 31 

4 13 16 

64 57 53 

100 100 100 

49 50 45 

-7 -5 11 

58 55 44 

100 100 100 

63 64 51 

-4 9 6 

41 27 43 

1Excludes nursing homss in France. 

NOTE Figures may not add to totals dueto rounding. 

Table M. Average annual rates of increase during 1950-78 in nominal 

values of medical care expenditures per capita, by services and goods: 

France and United States 

Care, services, and goods France United States 

Average annual increase 

(percent) 

All care, services, and goods ................. 14.1 8.8 

Hospital care. ..................................... 15.1 10.4 

Medical services .................................... 13.9 8.1 

Medical goods ....................................... 11.4 6.6 

1Includes nursing home care in the Uniteclstates. 

of care. In the United States and France, hospital 

expenditures seemed to increase most, followed by 

professional services; expenditures for medical products grew at a slower rate (table M). 

Contributions of price and volume to the growth 

of expenditures (figure 11) differed for the three main 

health care categories (hospital care, medical services, 

and medical goods). Prices carried less weight for 

medical goods, accounting for 20 percent of the growth 

in per capita spending in France and for 30 percent in 

the United States. Prices and volume accounted for 

almost an equal percent for hospital care, but for medical care for ambulatory patients and for home health 

care the proportion attributable to price increases 

(approximately 60 percent) exceeded that of volume of 

care expenditures (40 percent). These conclusions were 

valid in both countries despite differences in medical 

consumption levels and growth, the different role of 

third-party providers in the financial coverage of care 

and the setting of prices, and differences between the 

overall economic climate in the two countries. 

Distribution of expenditures 

Structures. —Changes in the distribution of expenditures by category of service are results of the 

differences in the availability of care and in the utilization of various services, as well as increases in corresponding prices. 

In both countries the proportion of hospitaI expenditures grew from 1950 to 1978. The amount spent 

for medical goods declined and medical services expenditures remained stable as a percent of the total 

(figure 5). 

The amount of expenditures attributable to hospitalization (hospitals and nursing homes) increased 

in the United States from 37.1 percent in 1950 to 

54.7 percent in 1978; expenditures for nursing homes 

increased more rapidly than expenditures for hospitalization. In France, expenditures are not reported 

separately for the two types of institutions, and the 

increased proportion of hospital services in total 

expenditures accompanied efforts to modernize and 

improve the comfort of hospitals and improve medical 

standards of homes for the elderly. 

Stability of the proportion of medical services 

expenditures is a phenomenon that indicates different 

situations for different professionals. Within the aggregate of medical services expenditures (excluding 

dental), the proportion spent on physicians’ services 

declined in both countries—85. 1 percent in France 

21 
15.1 14.1 

10.4 I 

r


8.5 

8.8 n 7.6 

II II 

France 

France 

Total medical Hospital and nursing 

care home caret 

1 ~xc[ude$ nursing homes in France. 

Nominal value: 

n Per capita relative value 

Ez2 General price index 

EEl Nominal medical care prica index 

m Per capita volume 

13.9 

12.8 

7.4 r-$r=-

6.4 8.1 

France 

France 

Medical services Medical goods 

Figure 11. Percent distribution of contributions of various factors to the increase in per capita expenditures by services and goods: 

France and United States, 1950-78 

and 91.1 percent in the United States in 1960, but only 

70.9 perc~nt in France and 66,6 percent in the United 

States in 1978. Correspondingly, the share of expenses 

for other professional services increased from 1960 to 

1978 from 8.9 percent to 33.4 percent in the United 

States, and from 14,9 percent to 29.1 percent in France. 

These figures indicate that, in both countries, 

treatment often involved care provided by professionals other than physicians; from an economic standpoint, the amount of activit y that physicians devoted 

to administering services declined and more physicians’ activities involved prescribing the services of 

other professionals. 

The decline in the proportion of expenditures for 

medical goods indicates the small increase in prices of 

22 

pharmaceuticals compared with other medical services. 

In France, the proportion of expenditures for medical 

goods declined from 28.9 percent in 1950 to 20.8 percent in 1978; nevertheless, this proportion remained 

higher during that period than in the United States, 

where the proportion of expenditures was 20.4 percent in 1950 and 11.3 percent in 1978. 

In 1966, introduction of Medicare and Medicaid 

in the United States resulted in better coverage for 

hospital care and apparently caused the share of 

pharmaceutical expenses as a percent of total expenditures to decline. Introduction of the programs also 

resulted in some substitution of hospitalization for 

ambulatory care. This service remained stable from 

1950 to 1965. 
Changes in the financing of medical care 

From 1950 to 1978, the structure of medical care 

financing changed as a result of the combined effects 

of several factors. 

1,	 An increasing number of individuals were covered 

under insurance systems. In France, Assurance 

Maladie was extended from industrial and commercial wage earners to cover agricultural workers 

and all independent professionals. In the United 

States, with the establishment in 1966 of the Medicaid and Medicare programs, the elderly (aged 65 

and over) and low-income individuals benefited 

by having a part of their medical expenses covered. In addition, an increasing number of people 

subscribed to private insurance plans for various 

health care services; for instance, 15from 1970 to 

1976, the percent of individuals under 65 years 

of age covered by insurance increased from 35.2 

percent to 62.2 percent for physicians’ services, 

from 6.6 percent to 24.0 percent for dental care, 

and from 53.5 percent to 76,3 percent for prescription drugs. 

2.	 Coverage of insured individuals improved. In 

France, the ticket nzoderateur (coinsurance) was 

eliminated for an increasing number of diseases. 

Agreements signed between Assurance Maladie 

and physicians in 1960, 1971, and 1975 insured 

better reimbursement for costs incurred. 

3.	 The structure of expenditures by category of service changed. The trend toward hospital care, which 

is better covered by third-party providers than 

other services, particularly was important. 

Changes in the distribution of health care expenditures by type of financing were evident in both countries by declines in the proportion paid directly by 

patients and by an increase in the amount of financing 

provided by third-party providers (figures 12 and 13). 

The percent of expenditures directly financed by 

patients, which is higher in the United States than 

in France, declined from 65.6 percent in 1950 to 

31.7 percent in 1976 in the United States; during the 

same period in France, it decreased from 39.4 percent 

to 21.8 percent (table N). 

The percent of expenditures covered by the public 

sector (Federal, State, and local governments) increased 

at a faster rate in the United States, from 22.4 percent 

in 1950 to 39.1 percent in 1976. This is less than French 

levels, where the population increased from 58.6 percent in 1950 to 74.5 percent in 1976. 

The percent of total expenditures paid by private 

insurance organizations, which is negligible in France, 

almost tripled in the United States, increasing from 

9.1 percent in 1950 to 27.0 percent in 1978. However, 

in 1966 and 1967, the proportion paid by private 

insurance declined as a result of the introduction of 

Medicaid and Medicare. This decline was temporary, 

and the increase resumed in 1968. 

The decline in the proportion of direct payments 

resulting from better coverage did not correspond to 

a decline but to an increase in the amount paid by 

patients. In current prices, this amount quadrupled 

in the United States, from $46 in 1950 to $191 in 

1976; it increased by 17 times in France (from 22 francs 

in 1950 to 471 francs in 1976). With adjustments for 

inflation, the amount paid directly by patients (in 

constant prices) almost doubled in the United States 

and quadrupled in France from 1950 to 1976. This 

amount was a stable proportion of the GNP in the 

United States (approximately 2.5 percent); the percent 

was lower in France but increased from 1.2 percent in 

1950 to 1.6 percent in 1960, to 1.5 percent in 1976. 

Improved social coverage, therefore, did not prevent 

individual expenditures from increasing at a rate equal 

to or greater than the economy, and it did not protect 

patients from increased medical care expenditures. 

23 
m Private insurance and 

other (United States), 

mutual insuranca ( France) 

B Diract payment by 

consumer 

Public funding 

Unitad States France 

1950 

1960 

1970 

1978 

Figure 12. Percent distribution of medical care expenditures, by type of financing: United States and France, 1950, 1960, 1970, and 1978 

24 
80 

70


60


50


E


Z40


i!


30


20


10


0 I 1 I I t I I


1950 1860 1970 1973 1976


Year 

1Includes funding by private insurance; philanthropy and other; and Federel, 

State, and local governments in the United Statea; and mutual insurance companiee, Social Security, and State and local governmentsinFrance. 

Figure 13. Percent of medical care expenditure, by third party payment


and direct payment by consumer: United States and France, 1950-76


Table N. Percent distribution of medical care expenditures, by type of financing: France and United States, 1950-76


1950 1960 1970 1973 1974 1975 1976


Type of 

United United United United 

States States States 

Percent dktribution 

All financing ................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

All private financing ........ 41.4 77.6 43.1 78.2 29.2 65.9 28.7 63.7 28.4 61.8 27.3 60.4 25.5 60.9 

Direct payments ............. 39.4 65.6 39.5 54.8 25.7 40.4 25.2 38.0 24.8 35.4 23.8 32.5 21.8 31.7 

Philanthrorw andother... . . . 2.9 . . . 2.3 . . . 1.5 . . . 1.4 . . . 1.4 . . . 1.3 . . . I*2 

Mutual insu}ance 

andothar ..................... 2.0 9.1 3.6 21.1 3.5 24.0 3.5 24.3 3.6 25.0 3.5 26.6 3.7 28.0 

All public financing ......... 58.6 22.4 56.9 21.8 70.8 34.1 71.3 36.3 71.6 38.2 72.7 39.6 74.5 39.1 

Public funds’ .................. 14.1 22.4 8.9 21.8 5.0 34.1 4.1 36.3 3.6 38.2 3.3 39.6 3.2 39.1 

Social Security ............... 44.5 . . . 48.0 . . . 65.8 . . . 67.2 . . . 68.0 . . . 69.4 . . . 71.3 . . . 

1[ncludes funding by Federal, Stata, and local governments in the United Stetes and by national and re9ional9overnmantain France. 

NOTE Figures may not add to totals due to rounding. 

SOURCE National Health Accounts. 

firranchg France States France 

United France States Frence 

United France State= France United France states 

25

Chapter Ill. Hospitalization 

Particularly in the United States, hospitalization 

is the major component of medical care utilization as 

well as an important economic activity—a source 

of employment. 

Hospital expenditures are defined differently by 

accounting systems of France and the United States. 

U.S. expenditures were redefined to correspond with 

French definitions (appendix). On the basis of these 

comparably defined statistics, hospital services were 

a per capita expenditure of 1,372 francs ($304) in 

France and $370 or $441 in the United States in 1978, 

depending on whether nursing homes are included 

with hospitals. Hospital sources also accounted for a 

larger share of total health care expenditures in the 

United States than in France in 1978—58.6 percent 

(or 49.2 percent excluding nursing homes) in the 

United States compared with 48.3 percent in France. 

Hospital expenditures in 1978 accounted for 4.4 

percent of the GNP in the United States (3.9 percent 

excluding nursing homes) and 3.4 percent of the GNP 

in France. In 1977, approximately 770,000 people 

were employed in this sector in France and 4.2 million 

people (including nursing home employees) in the 

United States—3.5 percent and 4.2 percent, respectively, of the employed population in France and the 

United States. 

Both countries classified establishments by services 

provided and patients who received services. Classifications included general hospitals, psychiatric hospitals, tuberculosis hospitals, and other hospitals that 

gave special care or served only specific patients (e.g., 

cancer and rehabilitation hospitals). Establishments 

also were classified as short-stay or long-stay facilities. 

However, statistical analyses indicated that these common headings covered different social and medical 

services in both countries. Some care provided in general or psychiatric hospitals in France probably was 

provided in nursing homes in the United States, in 

which patients essentially received nursing care. 

In France, homes for the elderly (hospices) and 

retirement homes do not have high medical standards 

and, therefore, were not considered part of the hospital sector. Strong efforts have been made to increase 

medical services in these institutions and transform 

them into treatment and convalescent homes, so that 

these institutions will be similar to American nursing 

homes. 

For the reasons discussed above, comparisons of 

levels of equipment, utilization, personnel, and other 

areas were made carefully. Data on nursing homes 

were included with statistics on hospitals. 

Distinction between ambulatory care and hospitalization is clear in France because public hospitals 

employ staff physicians and do not allow private physicians to attend hospitalized patients. In the United 

States, physicians are permitted to admit and care for 

patients in institutions that grant them. Outpatient 

services in hospitals are much more developed in the 

United States than in France. 

Hospital sector production 

Production capacity of hospitals usually is expressed in the number of beds; however, this factor is 

not an adequate indicator of quality of services 

or housing, which are the two aspects of hospital 

production. Therefore, production capacity must be 

supplemented by additional descriptive information 

on factors of production such as equipment and personnel. 

Capacity 

When general, psychiatric, and tuberculosis hospitals were considered, the number of beds in hospitals 

was 70 percent higher in France in 1977, 10.8 beds per 

1,000 population compared with 6.5 beds per 1,000 

population in the United States (table O). ‘6’17 

Higher density of beds in France was found for all 

types of institutions; however, the difference was less 

in general short-stay hospitals, for which density was 

30 percent greater, and was greater for beds in intermediate and long-stay institutions. 

26 
Table 0. Number of hospital beds per 1,000 population and averaga annual rates of increase during 1962-72, 1972-77, and 1962-77, 

by type of institution: France and United States, 1977 

1977 Average annual increase (oercent) 

France 1962-72 1972-77 1962-77 Type of institution United and France 

Statesl States2 States2 States2 

General shoti-stay..,, ............... 6.26 4.90 1.30 1.6 0.6 1.1 0.9 1.4 

General Iong-stay .................... 1.50 0.27 5.60 U -4.0 4.6 -4.2 4.8 -4.0 

Total general ........................... 7.76 5.17 1.50 1.6 1.1 1.3 0.9 1.5 1.0 

Psychiatric institutions ............ 2.56 1.32 1.90 1.7 -5.5 1.7 -11.3 1.7 -7.4 

Tuberculosis institutions ......... 0.43 0.02 21.50 -5.6 -12.9 -11.0 -30.1 -7.4 -19.1 

Total hospitals ......................... 10.75 6.46 1.70 0.9 -2.0 0.6 -2.7 0.8 -2.2 

Nursing care homes ................ . . . 35,54 . . . . . . 412.0 . . . 54.58 . . . 9.5 

Sections ..............m........o........... 0.20 . . . . . . . . . . . . . . . . . . . . . . . . 

Total ,,,.,,,,................................. 10.95 12.02 0.90 0.9 1.3 0.6 0.3 0.8 0.7 

1 Numberof beds per 1,000 population (France) 

Number of beds per 1,000 population (United States)” 

Zlncr@ses are computed for non-Fsderal howitak onlY. 

States United France United France United Frame United 

31n 1976. 

41963-73 period, 

61971-76 period, 

SOURCES: Ministbre de [e Ssnt6, Paris; American Hospital Aswciation (hospitals), Chicago; and the National Center for Health Statistics (nursing homes), Hyattsville, Md. 

Correct interpretation of these differences is contingent on recognition that in the United States nursing 

homes admit patients who, in France, would be cared 

for in intermediate-or long-stay hospitals, psychiatric 

institutions, and to a lesser extent in short-stay hospitals. Several characteristics also differentiate U.S. 

nursing homes from French hospices and retirement 

homes, although attempts have been made to compare 

these facilities. A National Center for Health Statistics 

survey found that 87 percent of all patients in nursing 

homes were admitted for physical reasons (illness or 

need for care) and 8.2 percent for psychological disorders. Only 7 percent were admitted for social or 

economic reasons. 18Furthermore, nursing home care 

often followed hospitalization—55 percent of the patients admitted to nursing homes were transferred 

from short- or long-stay general hospitals, psychiatric 

hospitals, or other nursing homes. This percent increased with advanced medical standards in these 

institutions. 

In 1976, nursing homes accounted for 5.5 beds 

per 1,000 population in the United States; 19nursing 

homes and related homesh together accounted for 6.5 

beds per 1,000 population. When services equivalent 

to French hospitals were considered, the density of 

beds in the United States was between 8.5 and 10.5 

beds per 1,000 population.i The difference in density 

of beds between France and the United States was less 

than expected if differences between hospitalization 

practices in the two countries were not recognized. 

h~‘Related homes” refers to personal care
homeswith or without nursing

services, and domiciliary care homes. 

iThis computation corresponds to the sum of hospital beds and 30 and 60 

percent, respectively, of nursing home beds. 

These densities of beds are similar to those in 1962 

(9.1 beds in the United States and 9.7 in France per 

1,000 beds); nursing homes were not yet common in 

the United States. 

Analysis of trends over time strengthened the 

hypothesis that in the United States nursing homes 

progressively have attracted a clientele that is cared 

for in hospitals in France. To meet the increase in the 

number of elderly and chronically ill people, the number of beds in intermediate and long-stay institutions 

and also in psychiatric institutions increased in France; 

in the United States, the number of beds has declined 

since 1966, but the density of beds in nursing homes 

has risen rapidly (9.5 percent per year from 1962 to 

1977). A similar movement toward improving medical 

standards of hospices, which would convert them into 

convalescent and treatment homes, is underway in 

France. 

Similar trends occurred in the number of beds in 

short-stay institutions, which increased in both countries; of beds in tuberculosis hospitals, which declined 

rapidly; and in total density of beds which, from 1962 

to 1977, increased 0.8 percent per year in France (hospitals) and 0.7 percent per year in the United States 

(hospitals and nursing homes). 

Technical equipment 

Hospitals adapt to the technical improvements in 

diagnostics and treatment by acquiring new equipment. 

Available statistics did not permit detailed comparative analyses but did indicate that in both countries, 

acquisition of technical equipment increased noticeably faster than the number of beds. For example, in 

French general public hospitals, the number of hemodialysis machines quadrupled from 1970 to 1976; the 

27 
number of high-voltage radiotherapy units almost 

doubled in 10 years. 20In the United States, L. Russell 

described the diffusion of several current technologies 

such as respiratory therapy, diagnostic radioisotopesis, 

electroencephalograph, and three “prestige” technologies—cobalt bombs, open-heart surgery, and renal 

dialysis. 21 

It appears that, despite the great effort by French 

hospitals, American hospitals provide more specialized equipment. 

Staff 

Similarly, the staff-to-bed ratio was higher in the 

United States than in France. In 1977, this ratio was 

2.3 full-time equivalents (FTE’s), compared with 1.2 

FTE’s in France for all hospital institutions. This 

difference partially was due to the larger number of 

tuberculosis and psychiatric institutions in France, 

which have lower ratios; however, the difference also 

was found in all general hospitals, for which the ratio 

was 2.6 FTE’s per bed in the United States and 1.5 

FTE’s in France. 

The staff-to-bed ratio increased in both countries, 

because the number of personnel grew faster than the 

number of beds to permit development of hospital 

“hotel” services and use of new medical equipment; 

therefore, the staff-to-bed ratio increased. For all 

hospitals, the increase from 1962 to 1977 averaged 5.4 

percent annually in the United States and 3.8 percent 

in France. However, for general hospitals only, the 

growth rate was more rapid in France (4.5 percent per 

year) than in the United States (2.9 percent). Although 

rates of increase did not vary in subperiods in the 

United States, acceleration was noticeable in France 

during the 1972-77 period, particularly the increase of 

6.5 percent per year in the staff-to-bed ratio in general 

hospitals (table P). These increases allowed hospitals 

to change production in quantity and kind. They particularly contributed to intensification of care over 

shorter periods of time and to development of outpatient visits. 

Hospital production and utilization of 

hospital services 

Measuring production and utilization of hospital 

services raises problems of definition because hospital 

activities encompass many components, and the variables that describe them do not always have the same 

meaning. Established customary measurements such 

as the number of days or admissions were used, and 

data on length of stay and on types of care received 

during hospitalization were added to account for evolution of treatment methods. 

Frequency of admissions to hospitals is similar in 

both countries—approximately 17 admissions per 100 

population in 1977. However, because of the longer 

lengths of stay in France, days of hospitalization per 

capita were 76 percent higher than in the United States 

(table Q). 

Interpretation of this initial information on hospital utilization accounted for differences in the scope 

of the statistics between the two countries—patients 

convalescing in nursing homes were excluded from 

Table P. Number of full-time equivalent staff per bed, ratio, and average annual rates of increase during 1962-72, 1972-77, and 1962-77, 

by type of institution: France and United States, 1977 

1977 level Average annual increase (percent) 

France 1962-72 1972-77 1962-77 

Frence States United 

StatesJ France United States France United 

States France United States 

General short-stay ........................ . . . 2.65 . . . . . . 2.7 . . . 2.6 . . . 2.7 

General long-stay ......................... . . . 1.40 . . . . . . 2.9 . . . 3.7 3.1 

Total general ................................ 1.46 2.59 0.56 23.8 2.9 %3.5 2.9 245 “: “ 2.9

Type of institution United and 

Psychiatric institutions ................. 0.57 1.10 0.52 . . . 6.7 .-. 10.4 . . . 7.9 

(public 75) 

0.69 

(private 77) 

Tuberculosis institutions .............. 0.49 0.0 . . . . . . . . . . . . . . . . . . . . . (private 77) 

% .21 %28 0.53 %.5 5.2 52.9 5.8 52.0 5.4 

63.0 65.4 63.8 

Nursing care homes ..................... . . . 4,70.50 . . . . . . . . . . . . . . . . . . . . . . 

1 Number of full-time equivalent staff per bed (France) 

Number of full-time equivalent etaff per bed (United Statea)” 2GeneraI public hospitalsonly. 

3Eatimate.


%s rste would equal 1.46 if the total of hospitals plus nursing homesware concluded(commentL Russell).


5Privatehospitalsonly.
 6*[1 general pub]i~ hospita!a and all Private hoapitala. 

71976. 

SOURCES Ministbre de la Sant6, Paris; American Hospital Association (hospitals), Chicago; and the National Center for Health Statistics (nursing homes),Hyattsville,Md. 

28 
U.S. statistics. Hence, the data showed that hospital 

days for all institutions in 1977 numbered 3.2 per 

person in France and 1.8 per person in the United 

States. For short-stay care only, the difference between 

the two countries was 35 percent less, with 1.8 days 

per person in France and 1.3 days per person in the 

United States (table R). 

For general hospitals, the average length of stay 

was 66 percent higher in France, or 12.9 days compared 

with 7.8 days in the United States. For short-stay hospitals alone, this difference was much less (23 percent 

higher in France) and the average length of stay was 

10.9 days in France and 7.6 days in the United States 

(table S). 

Table Q. Number of hospital admissions per capita, ratio, and average annual rates of increase during 1962-72, 1972-77, and 1962-77, 

by type of institution: France and United States, 1977 

1977 level Average annual increase (percent) 

France 7962-72 1972-77 1962-77 

Frame States United France Statesl 

United 

States 

France United 

States France United States 

General short-stay .,...,.,,,,,,,,,... 16.57 16.67 0.99 3.9 1.2 3.8 1.6 3.9 1.3 

General long-stay .................... 0.76 0.08 9.50 7.2 -4.6 4.8 -4.4 6.4 -4.5 

Total general ............................ 17.33 16,75 1,03 4.0 1.1 3.8 1.6 3.9 1.3 

Psychiatric institutions ............ 0.50 0.31 1.61 2.4 10.8 -0.7 6.3 1.4 

Tuberculosis institutions ......... 0.07 0.00 . . . -;; -10.4 -2.6 -9.7 -2.3 -10.2 

Total hospitals ......................... 17.90 17.06 1.05 3.9 1.1 3.9 1.3 3.9 1.2 

1 Number of hospital admissions per 100 population (France) 

Number of hospital admissions per 100 population (Unitad States)” 

SOURCES Minist&e de la Sant& Pari$ and the American Hospital Aeaocistion, Chicago. 

Type of institution United and 

Table R. Number of hospital days per capita, ratio, and average annual rates of increase during 1962-72, 1972-77, and 1962-77, by type of 

institution: France and United Statas, 1977 

1977 level Average annual increase (oercent) 

Type of institution United France States 

France 

and 

United 

Statesl 

1962-72 

France United 

States 

1972-77 

France United 

States 

1962-77 

United France States 

General short-stay ................... 1.80 1.33 1.35 1.0 1.5 0.3 0.8 0.8 1.3 

General long-stay .................... 0.42 0.08 5.25 5.8 -2.2 3.7 -5.6 5.1 -3.3 

Total general ........................... 2.22 1.41 1.57 1.6 1.2 0.9 0.5 1.4 1.0 

Psychiatric institutions ............ 0.87 0.39 2.23 1.1 -6.3 -0.7 -11.4 0.5 -8.1 

Tuberculosis institutions ......... 0.08 0.00 . . . -7.4 -16.4 -16.7 . . . -10.6 . . . 

Total,,,,,,,,,,, ........................... 3.17 1.8o 1.76 0.5 -2.6 -0.1 -3.2 0.3 -2.8 

1 Numbar of hospital days per 1,000 population (France) 

Number of hospital days par 1,000 population (United States)” 

SOURCES: Minist&re de la Sant6, Paris; and the American Hospital Association, Chicago. 

Table S. Average annual length of stay in days per capita in hospitals, ratio, and average annual rates of increase during 1962-72, 1972-77, 

and 1962-77, by type of institution: France and United States, 1977 

1977 level Average annual increase (percerrfl 

France 1862-72 1972-77 1962-77 

France States United 

States-l France United 

States 

France United 

States France United States 

General short-stay ................... 10.88 7.60 1.43 -2.8 0.4 -3.3 -0.8 -2.9 . . . 

General Iong-stay .................... 55.78 155.80 0.36 -0.3 0.9 -1.5 0.1 -0.7 0.6 

Total general ........................... 12.85 7.75 1,66 -2.2 -0.2 -2.8 -1.6 -2.4 -0.6 

Psychiatric institutions ............ 174.47 131.20 1.33 -3.6 -8.5 -7.7 -11.1 -5.0 -9.4 

Tuberculosis institutions ......... 123.06 60.83 2.02 -2.9 -6.3 -12.4 -10.2 -6.2 -7.5 

Total hospital..,., .................... 17.83 10.50 1.70 -3.3 -3.7 -3.7 -4.6 -3.4 -4.0 

Type of institution United and 

1 Average annual length of stay (France) 

Averageannual length of stay (United States)” 

SOURCES: Ministbre de la Sant6, Paris American Hospital Association (hospital), Chicago; and the National Center for Health Statistics (nursing homes), Hyattsville, Md. 

29 
--

--

---- ------ -------

Values of staff-to-bed ratios suggested that, in the 

United States, the amount of care received per day 

and the quality of hospital hotel services were higher 

than they are in France. This hypothesis, which assumes similar levels of personnel productivity, could 

not be tested because there is no overall index of the 

volume of services received per day that could support 

the comparison. 

Changes 

Since 1972, the number of days spent in psychiatric 

hospitals declined in both countries, but this decline 

was greater in the United States. For tuberculosis 

hospitals, this decline in the number of days spent also 

was greater in the United States and occurred during a 

longer period. 

Short-stay hospitals were a more comparable group 

of institutions than all other hospitals in these two 

countries. When short-stay hospitals were examined 

alone, the average number of admissions and of days 

per person in France and the United States increased 

from 1962 to 1977. The number of admissions per 100 

population increased faster in France than in the 

United States—an average rate of 3.9 percent per year 

from 1962 to 1977, compared with 1.3 percent in the 

United States. Because of this, the difference between 

the two countries, which was 10 percent in 1973, disappeared. 

From 1962 to 1977, length of stay in the United 

States was stable, despite a slight increase after the 

Medicare and Medicaid programs were introduced; 

by contrast, length of stay in France (which had an 

average of 17.0 days in 1962) declined 2.9 percent per 

yearj (figure 14). 

Because of the offsetting effects of changes in 

admissions and lengths of stay, the trend in the number of hospital days per person was similar in both 

countries—the number of days per person increased 

approximately 1 percent per year from 1962 to 1977. 

Several partial indicators show the transformation 

of hospital care and the growth in the services provided 

per hospital day. For example, the American Hospital 

Association estimated that from 1972 to 1975, the 

amount of services provided per day in the United 

States increased an average of 3.7 percent per year, 22 

the number of laboratory examinations per day increased an average of 11.1 percent per year from 1969 

to 1976,23and the number of surgical operations per 

admission increased by 3 percent per year from 1970 

to 1977.XIn France, the growth in volume of care from 

1965 to 1976 was approximately 5 percent per year per 

admission and approximately 9 percent per day. 20 

Development of outpatient services increased rapidly in both countries, and the number of outpatient 

jThi~ decline may be attributed to publichospitals, for which the length 

of stay was 19.8 days in 1962 and 10.8 days in 1977. 

30 

France 

— Public hospital 

Short-stay public hospitals 

II,,,,,,,Short.stay p~i”st~h~~pit~l~ I 

Unitad States 

Short-stay “community” hospitals 

24 

22 

20 

18 

16 

14 

12 -\ !t!!l!! ll!!l!!!l!!rl l!rl!tl,,,,,, !,,,,,,,, $,,,,,,,,,,,,,,,,,,,,, i,!!~ '````“‘“%,,,,,,t% 

. . 10 

8 // 

o~ 

1881 1865 1970 1975 1978 

Year 

Figure 14. Average length of stay in generaI hospitals, by type of 

hospital: France and United Statesr 1961-78 

visits per admission increased at an average yearly rate 

of 3.8 percent in France and 4.8 percent in the United 

States. 

This phenomenon must be viewed by considering 

two hospitalization features. Development of outpatient services brings new clienteles to hospitals, which 

contributes to the demand for high-intensity inpatient 

care by serving a concentration of numerous diagnostic 

examinations in a short period. On the other hand, the 

opportunity for hospital physicians to follow patients’ 

progress using outside consultations also contributes 

to shortening patients’ length of stay. The decline in 

lengths of stay leads to shifting of the hospital costs 

to the ambulatory care sector. 

These changes in hospital production (the growth 

of inputs per unit of production and the intensification 

of care) contributed to the rapid increase in prices in 

this sector. 

Hospital prices 

The changing nature of hospital production precludes simple analysis of trends in the hospital sector. 
I 

Growth in prices per day or admission (the units used 

to measure hospital production) is a poor indicator 

because it indicates changes in units rather than hospital production; as shown previously, the quantity 

of hotel and medical services corresponding to 1 day or 

one admission increased. Therefore, to clarify changes 

in prices and show growth in hospital costs if quantity of production inputs remained constant, hospital 

cost indexes were developed in France and the United 

States. 

The following analysis of hospital prices accounts 

for the factors discussed above. 

Prices per day and per admission 

Using current data, prices per day could not be 

compared between institutions or services in the two 

countries. In particular, costs billed by physicians to 

patients in hospitals (part of the cost of a hospital) are 

difficult to estimate. However, a single hospital day 

was billed at a higher rate in the United States than in 

France (table T). 

In general hospitals, the average 1977 price per 

day in France was 338 francs ($69), which was 60 

percent lower than the average price per day in a U.S. 

community hospital ($194). This significant difference 

could not be attributed entirely to the large number of 

acutely ill patients in U.S. community hospitals or to 

average length of stay—7.6 days in U.S. community 

hospitals and 12.8 days in French general hospitals. 

The difference in price per day between the two 

countries was 40 percent; this difference decreased 

when prices per admission in short-stay hospitals were 

compared. In the United States, the 1977 price per admission in short-stay hospitals was $1,494; in France, 

the price was 4,092 francs ($833). 

Growth in prices per day for all institutions in 

NV’s was more rapid in France (figure 15). Therefore, 

for 1950-77, the average annual rate of increase was 

9.9 percent in the United States and 13.0 percent in 

France. In both countries, the rate of growth accelerated from 1970 to 1977, to 19.6 percent per year in 

France and to 13.6 percent per year in the United 

States. 

Because length of stay declined in France, the 

difference between the two countries is less marked 

for the growth of prices for a hospital stay, which increased during 1972–77 by 13.9 percent per year in the 

United States and by 16.6 percent in France (table T). 

When these patterns are compared, the general 

inflation rate must be considered in both countries 

and at different periods by analyzing the rates of increase in relative prices (i.e., nominal prices deflated 

by the GPI). 

By this index, changes in price per day were much 

closer in the two countries, with an average annual 

rate of increase of 6.7 percent in France and 6.2 percent in the United States from 1950 to 1977 (table U). 

However, during 1970-77, growth in price per day in 

constant currency was more rapid in France (9.7 percent per year) than in the United States (6.6 percent 

per year). This marked acceleration in France was 

linked to the increase in personnel and to the decline 

in lengths of stay during the same period. Similarly, 

from 1972 to 1977, the price per admission in shortterm institutions (in constant currency) followed the 

same trend—5.7 percent per year in France and 5.8 

percent per year in the United States. 

Table T. Cost per patient day in France and the United States, cost per admission, and ratios in general short-stay hospitals, 

with average annual rates of increase during 1972-Z? France and United States, 1972-77 

Per diem price Price per admission (short-term) 

France: Unitad States: France France: United States: Franca 

Year and factor public and private community and public and private community and 

general hospitals~ hospitals2 United general hospitals hospitals2 United 

Francs Dollars Dollars States3 Francs Dollars Dollars States 

Year 

1972 .................................. 132.8 26.3 98.5 0.3 1,900.9 376.9 778.2 0.5 

1973 ,,s,,,..............,,,. ..,.,,..., 150.1 33.7 107.3 0.3 2,096.9 470.8 836.9 0.6 

1974 ,,,,,, ,,,...,,,0,................. 175.9 36.6 118.5 0.3 2,394.7 488.3 924.6 0.5 

1975 .................................. 222.7 51.9 142.0 0.4 2,932.8 682.8 1,093.4 0.6 

1976 .................................. 286.3 59.9 167.9 0.4 3,598.4 752.9 1,292.6 0.6 

1977 ,,.,,.......,,,,,,.. .............. 338.1 68.8 193.9 0.4 4,091.5 832.7 1,493.9 0.6 

Average annual increase (percent) 

Factor 

Nominal price .................... 20.60 21.20 14.50 16.57 17.18 13.93 

General price index ........... 10.34 7.69 10.34 7.69 

Ralative price., ................ 9.29 6.32 5.65 5.79 

1TOtalgeneralp~b~~and ~fivate h~~pital~ ~OstfOrstay only, fees for treatments not included. Source S. Sandierand F.Tonnelfier, Medical mre consumption in the Contefi ‘f 

Social Security GensralHealth Insurance(;o be published).


2Revenueper patient day (not including fees for private physicians). Source American Hospital Association (hospital statistics), Chics90.


3Cost per patient day in dollars (France) . 

Revenueper patient day (United States) 

4Rlce per patient day (estimated to be I I percent higher than that of all hospital), multiplied by avera9elength ‘f ‘ay. 

31 
----

_ Nominal price index 

--—- Relative price index 

IIIMI,I,ItIIiM Nominal hospital care index 

Relative hospital care indgx 

4,000 France 4,000 United States

3,000 3,000 

2,000 2,000 

1,000 1,000 

500 500 

100 100 

1950 1955 1960 1965 1970 1978 1950 1955 1960 1965 1970 1978 

Year Year 

NOTE: 1950 indexes = 100. 

Figure 15. Hospital costs, by selected factors: France and United States, 1950-78 

Table U. Average annual rate of increase in nominal and relative prices per patient day: France and United States, selected periods during 1950-77 

Selected period Nominal Rice Relative Fkice 

Francel United States* Francel United States* 

1950.n ............................................................................................................. 13.0 9.9 6.7 6.2 

1950.60 ............................................................................................................. 11.6 7.5 5.6 5.3 

1960-70 ............................................................................................................. 10.1 9.7 5.8 6.7 

1970.n ............................................................................................................. 19.6 13.6 9.7 6.6 

lAII ~ub~cand pflvata hoapitala (cost Of S@Y and fees). 

2Non.FsderaI, ~ho~.term, general, and other(AmericanHospitalAssociation)(costof staY).

This analysis suggested that hospital prices evolve 

chiefly as a function of two factors—general inflation 

and increases in the quantity of production inputs 

necessary during a hospital day or length of stay. The 

following analysis clarifies these points. 

Structure of hospital costs and cost index of 

hospital care 

Hospital costs may be divided schematically into 

two components—costs associated with personnel (salaries and fringe benefits) and productive factors that 

32 
represent intermediate consumption such as food, energy, and pharmaceutical services. 

In both countries, expenditures for personnel account for more than 60 percent of all production 

costs; however, in France, the proportion is higher. In 

1977, personnel expenditures accounted for 65 percent 

of the operating costs in general public hospitals in 

France, compared with 60.4 percent in the United 

States ok 

This difference in the two countries was expected 

to be the reverse because the staff-to-bed ratio is higher 

in the United States. Larger personnel expenditures in 

France probably were the result of higher benefits 

in Fran~e and more equipment in Amer=an hospitals 

(which reduces the number of personnel). 

Growth in hospital costs is due to the simultaneous 

effects of increases in the amount and prices of inputs 

used in production. The latter component maybe isolated by using the cost of care index. 

From 1950 to 1969, this index was compiled as the 

sum of the index of increases in salaries, weighted by 

the share of salaries in total production costs and the 

GPI, weighted by the share of other inputs in production costs. The AHA cost index has been used 

since 1969. The Health Care Financing Administration, 

however, also computed a cost index for hospital inputs; the results were received too late to be included 

in this report. The growth rates are similar to the ones 

used in this report. 

From 1950 to 1977, the cost index for hospital care 

increased yearly by an average of 5.5 percent in the 

United States and by 7.4 percent in France; however, 

in relation to the GPI, the growth rate was similar in 

both countries—1.8 percent per year in the United 

States and 1.3 percent in France. Differences observed 

in subperiods (figure 15) primarily reflect the variability of general inflation. The growth in the cost of 

hospital care at relative prices seldom was outside the 

range of 0.5 to 2.0 percent. This result is not surprising, because for 40 percent of production inputs the 

growth in prices followed the GPI closely; for the 

remaining 60 percent, prices increased slightly faster 

because salaries of low-paid staff members increased 

faster than the GPI. 

Comparison between changes in prices per day and 

the cost of care index clarifies evaluation of the total 

quantity of inputs used for the production of a hospital day, 

During 1950-77 the daily average showed 5.3 

percent more inputs in France and 4.2 percent more 

inputs in the United States (table W). These data complement the study of growth in personnel and show 

kThi~ information ~a~ retrieved from 1977 national accounts for France. 

Table W. Average annual rate of increase in volume of production inputs 

per day France and United States, selected periods 1950-77 

Selected period France United Statas 

Avarage annual increase 

(percent) 

1950.7 ................................................. 5.3 4.2 

1950.60 ................................................. 5.0 3.0 

1960.70 ................................................. 3.7 4.6 

1970.n ................................................. 8.1 5.4 

that other inputs developed similarly. The more rapid 

increase in volume of inputs per day in France from 

1970 to 1977 (8.1 percent per year) was probably the 

cause of the sharp decline in length of stay. 

The contribution of the different parameters to the 

growth of price per day maybe determined (table Y) 

Table Y. Parcant distribution of contribution of various factors to the 

growth of price per day, according to selected perioda 

F?ice Volume Relative General 

Selected period per of inputs cost of price 

day per day care index 

Percent distribution 

1950-60 

France ...................... 100 44 

United States .......... 100 41 3: : 

1960-70: 

France ...................... 100 38 21 41 

United States .......... 100 48 22 30 

1970-n 

France ...................... 100 44 8 48 

United States .......... 100 41 9 50 

1950-7Z 

France ...................... 100 42 11 47 

United States .......... 100 43 20 37 

by observing that: 

� The two countries have obvious similarities. 

�	 The increase in volume of inputs in France and 

the United States over different periods accounted 

for approximately 40-50 percent of the increase in 

the price per day. 

�	 The contribution of the GPI is variable, ranging 

from 29 percent in the United States from 1950 to 

1960 to almost 50 percent in both countries during 

the 1970-77 period of high inflation. 

�	 The contribution of relative price increases is more 

varied ranging from 6.0 percent in France from 

1950 to 1960 to 30 percent in the United States 

during the same period. 

These percents aid in defining possibilities for 

moderating the growth in price per day. The effect of 

33 
general inflation is important and mechanical, and its 

influence cannot be curbed at the health care policy 

level. Limiting growth in the volume of production 

inputs would contain costs but also would restrain development of health care techniques and methods. 

Hospital expenditures 

Comparison of hospital expenditures covers hospital and nursing home expenditures in the United 

States and hospital expenditures in France. The scopes 

of these two aggregates are reasonably comparable; 

however, expenditures are not constructed according 

to the same concepts in both countries. In France, 

hospital expenditures include costs of stay and fees to 

physicians paid by hospitalized patients; in the United 

States, they encompass care to outpatients, but exclude fees to private physicians. 

To account for these differences, hospital expenditures in the United States were revised to 

include all costs for inpatients (see appendix) and 

amounted to $441 in 1978, 45 percent more than the 

expenditures in France, 1,372 FF ($304). 

Because of a lack of information, comparison of 

rates of change computed from unadjusted American 

and French statistics were assumed to be valid. These 

statistics indicated that expenditures in both countries 

in current prices increased more rapidly in the hospital 

sector than in any other sector of medical care. 

From 1950 to 1978, the annual rates of increase 

averaged 15.1 percent in France and 10.4 percent in 

the United States (figure 16). The growth rate in 

France was higher when the impact of general inflation was eliminated. From 1950 to 1978, the relative 

value of per capita expenditures increased by an 

average of 8.5 percent per year in France and 6.5 

percent per year in the United States (figure 17). The 

rate of growth in volume (expenditures deflated by 

the cost of care index) also was greater in France– 

approximately 7.1 percent per year from 1950 to 

1978, compared with 4.6 percent per year in the 

United States (figure 18). However, in both countries, 

the number of hospital days per capita rose slowly 

(approximately 1 percent per year); therefore, increase in prices per day clearly was the determining 

factor in growth in expenditures (figure 19). The 

increase in prices per day may be separated into 

volume and prices of inputs. The contributions of 

price per day to the growth in hospital expenditures 

was important. In comparison the increase in the 

number of hospital per capita days explains only 12 

percent of the growth in per capita expenditures in 

France during 1950-77 and 4.0 percent in the United 

States (table Z). 

Other expenditure breakdowns are possible based 

on information concerning types of production inputs and qualifications and salaries of personnel .zo’u 

These factors indicated that approximately half of the 

increase in hospital expenditures was explained by 

growth in the volume of production inputs used (personnel and equipment) and the other half by the rise 

in the prices of these inputs, which primarily reflects 

general inflation. 

Summary 

Comparison of the two countries showed that per 

capita hospital expenditures were higher in the United 

States, despite more rapid growth rates in France in 

nominal value, relative value, and volume. 

Analysis of expenditures for a single year and for 

changes over time produced common results—neither 

number of beds nor length of stay explained disparities 

in the two countries. Rather, production inputs (personnel and equipment) affected level and growth of 

expenditures while permitting different organization 

of hospital activity. 

The number of beds and lengths of stay are higher 

in France, yet the admission rate is similar in both 

countries. The United States leads in the number of 

personnel per bed and in the amount of equipment, 

which partly explained shorter lengths of stay and the 

trend toward outpatient visits. In all of these areas, 

trends in France have grown increasingly similar to 

the trends set by the United States, which served as a 

model. This tendency for the two countries to become 

Table Z.	 Average annual rate of increase of various factors and percent distribution of thair contributions 

to the increase in per capita hospital axpenditurea: France and United Statea, 1950-77 

Average annual rate Contribution to the 

of increase growth of expenditures 

Factor ~ercent) (percent) 

Frame United States Frama United Stetes 

Percent distribution 

Expenditures per capita ..................................................................................... 15.0 10.3 100 100 

Number of daya per capita ..................................... ........................................... 0.4 4 

Volume ofcare per day ...................................................................................... F3 4.2 : 40 

Relativa cost of care ........................................................................................... 1.3 1.9 9 

Ganeral price index ............................................................................................ 5.9 8.8 41 : 

3+4+ 5 Average price per day .......................................................................... 13.0 9.9 88 96 

34 
Nominal value: 

n Per capita relative value 

EzzzlGeneral price index 

B Hospital price index 

:jj.y#:::::::

:.:.:.*:::::::::::: Per capita volume D. . . . . . . . . 

15.1 14.5 

13.5 11.5 

-n7.2 7“3 +--Fl 

8.5 

United I 

France States 

France France 

France 

1950-78 1950-60 1960-70 1970-73 1973-78 

NOTE: Figures shown on the chart indicate average annual increase rates (percent) of the various fastors. 

Figure 16. Percent distribution of the contributions of various factors to the increases in per capita hospital expenditures: 

United States and France, 1950-78 

35 
I 

m ‘ran” 

16
 m United Wales 

14


13


12


11


10


9


8


7


— 6


5


4


3


2


1


0 

1950-78 1950-60 1960-7() 1970-73 1973-74 1974-7!5 1975-76 1976-77 1977-78 

Period 

‘ Includes nursing homes in the United States. 

2 Nominal value deflated by the general Price index. 

Figure 17. Average annual rate of increase of per capita hospital’ expenditures, in relative value2. . France and United Statea, selected periods from 

1950 through 1978 

36

12 

— 11 

10 

9 

8 

7 

6 

5 

4 

3 

2 

1 

0 

1950-78 1950-60 1960-70 1970-73 1973-74 1974-75 1975-76 1976-77 1977-78 

1 ,nclude~ n~r$ing homes in the unitad,states Period 

ZNOminal “clue deflated by the nominal price index for hospital Servic= 

Figure 18. Average annual rate of increase ofpercapita hospitall expenditures, inconstant prices2: France and United States, selected periods 

from 1950 through 1978 

37 
---

---

_ Nominal value per capita 

6,000 1111111111111111 Relative value per capita 6,000 

5,000 Volume ofmedical care percapita 5,000 

. . . . . . . . . . Number ofdaysper capita 

4,000 4,000 

F 

3,000 3,000 

t 

2,000 2,000 

France United States 

I 

1,000 1,000 

900 900 

800 800 

700 700 

600 600 

500 500 

400 400 

1 

300 – 300 

per day 

200 — 

... .... ..... ......... \ 

\ 

Inn 11111111111111111 100 

1950 1955 1960 1965 1970 1978 1978 1970 1965 1960 1955 1950 

Year Year 

NOTE: 1950 indexes =100. 

Figure 19. Changes in per capita hospital expenditures, by selected factors: France and United States, 1950-78 

38 
similar was especially clear in the most recent period 

studied (1972-1977). 

Analysis of factors that contributed to change 

showed similarities in the two countries. In particular, 

the analysis emphasized the need to consider general 

inflation in the study of expenditures (because it has 

mechanical effects on production costs) and to link 

growth in prices per day to the changing meaning of 

a day (because this factor corresponds to increases 

I in medical and hotel services). 

Because health care policy cannot alter general inilation rates, containment of hospital costs depends 

on setting maximum rates of growth for production 

inputs. Justifications for such a decision have yet to 

be found. From an economic standpoint, it should 

be noted that in the United States, which does not 

have compulsory health insurance, people voluntarily 

purchase private insurance to cover the risks of hospitalization. From a health standpoint, containment 

measures would be justified only if one believes that 

the further growth of the means of care does not help 

sat isfy patients’ demand for the improvement of their 

health in conditions of greater security and comfort. 

Conclusions 

The comparative analysis of health care expenditures in France and the United States through 1978 

led to several conclusions. As the earlier study showed, 

differences between the two countries were greatest 

in expenditure levels, financing structures, and distribution of health care by service category in a given 

year. By contrast, trends observed in France and the 

United States share several characteristics such as rapid 

growth in hospital expenditures, less rapid growth for 

pharmaceutical expenditures than total expenditures, 

increasing public sector role in health care financing, 

and the declining proportion of costs paid directly by 

the patients. 

The result of these changes, although more accentuated in one country than the other, showed increasing similarity between France and the United States. 

Per capita medical expenditures were higher in the 

United States, but the gap between the two countries 

was decreasing because of the faster growth rate in 

France. The proportion of financing by third-party 

providers was greater in France but was increasing 

faster in the United States, and the proportion of 

direct payments by patients was declining more quickly 

in the United States. The share of expenditures that 

may be attributed to pharmaceutical services was 

greater in France but was declining at a more rapid 

rate than in the United States; however, hospital expenditures were a greater percent of total costs in the 

United States but were increasing more rapidly in 

France. 

This tendency toward uniformity appeared again 

when operation of the hospital system was studied in 

detail. The United States served as the model because 

lengths of stay in short-stay institutions were declining 

at a faster rate in France and nearing the values observed in the United States; the number of personnel 

was increasing faster in France, but the staff-to-bed 

ratio remained higher in the United States; and development of care for the elderly in institutions, which in 

the United States increased the number of nursing 

home beds, was comparable in France to improvement 

of medical standards in hospices which were becoming 

the equivalent of convalescent homes. 

Study of trends 

The study of trends for 28 years in two countries 

demonstrated the need to consider rates of increase 

in the economy, general inflation, and medical care 

prices. Analysis of growth in expenditures at relative 

or constant prices supported redefinition of the initial 

analysis based on nominal values. 

In both countries the 1973-78 period was marked, 

but to different degrees, by a simultaneous decline 

in economic growth and an acceleration in the rate of 

inflation. 

By 1978, medical expenditures rose as a proportion 

of the GNP to 7.1 percent in France and 8.0 percent in 

the United States. As a result, the governments in both 

countries have been increasingly concerned with the 

growth in health care expenditures. Although total 

medical expenditures increased more in both countries 

from 1973 to 1978 than in earlier periods, growth in 

volume decreased considerably in the United States 

and to a lesser degree in France. 

One result of the analysis of the most recent period 

was that elasticities calculated with respect to the GNP, 

which were useful parameters in periods of economic 

growth to predict the increase in use of medical care 

at current prices or in volume, lost meaning during 

economic stagnation or recession. For the short term, 

it was concluded that growth in medical care expenditures was independent of the general economic climate. 

Whether this will continue could not be determined. 

Role of financing method 

The role of financing methods in growth of medical care appeared minor compared with that of the 

organization of the distribution of health care and 

technical progress. 

Comparison of the two countries indicated that if 

health insurance is not compulsory and is not the 

responsibility of the government, people tend to rely 

on private insurance to protect themselves against the 

risk of illness and to limit direct payments. 

39 
However, since France has a general health insurance plan the impact of economic crisis on the health 

care sector apparently was minimized. 

By taking advantage of the fee negotiations with 

suppliers of medical services, Assurance Maladie caused 

relative prices of physicians’ and pharmaceutical services to decline from 1973 to 1978. 

In the United States, overall medical care prices 

increased at an average annual rate of 1 percent more 

than the inflation rate; relative prices for medical care 

declined by 0.7 percent per year in France. 

Control of fees for ambulatory and pharmaceutical services prescribed by Assurance Maladie in France 

may explain lower pharmaceutical prices and why 

consumption of pharmaceutical products accounts 

for a higher percent of total medical expenditures in 

France. 

In both countries, controls on the development of 

hospital equipment have been thought to limit growth 

in health care expenditures. The American certificates 

of need and the French carte sanitaire were responses 

to this view. However, application of such measures 

were resisted at the local level, where hospitals often 

represent regional development and sources of employment, and also were opposed by populations deserving 

up-to-date equipment available nearby. 

Life expectancy at birth, a common but imperfect 

indicator of health, increased over these years for men 

and women. In the United States, life expectancy was 

shorter than in France, but the increase has been more 

rapid. It is not possible to state whether these trends 

were the result of the spread of medical care or changes 

in lifestyles. The effect of medical care was difficult to 

determine because illness can be both the reason for 

and sometimes the result of care. A study of regional 

differences within each country, which are more pronounced than the differences between the national 

averages of France and the United States, might clarify 

this effect. 

During 1950-78, increases in prices and volume of 

health care in both countries contributed to approximately half of the increase in per capita medical care 

expenditures. However, because of high inflation rates 

from 1973-78, the amount that may be attributed to 

volume of health care declined to 27 percent in the 

United States and 41 percent in France. 

This demonstrates the mechanical impact of inflation on growth in cost of services and, therefore, on 

growth in health care expenditures. Because inflation 

rates cannot be controlled by health care policymakers, 

containing health care costs limits growth in the amount 

of care provided. Justifications for such an approach 

remain to be found. 

40 
~ 

References 

1Rosch, G,, and Sandier, S.: A comparison of the health-care 

systems of France and the United States, in T. W. Hu, ed., 

International Health Costs and Expenditures. DHEW Pub. No. 

(NIH) 76-1067. Nationrd Institutes of Health. Washington. U.S. 

Government Printing Office, 1976. 

2Lacronique, J. F.: Technology and Medicine in Contemporary 

France. Communication to the National Institutes of Health, 

Fogarty International Center, Bethesda, Md., Apr. 16, 1976. 

3Reinhardt, U.: An Overview of Foreign Health Insurance Systems, International Workshop on National Health Insurance, 

Reston, Vs., Sept. 26-27. 

4Kleinman, J. C., and Wdson, R. W.: Are medically underserviced 

areas medically underserviced? Health Serv. Rer. 12(2):147-62, 

Summer 1977. 

‘Rice, D., and Wilson, D.: The American medicat economy— 

problems and perspectives, in T. W. Hu, ed., International Health 

Costs and Expenditures. DHEW Pub. No. (NH+) 76-1067. National Institutes of Health. Washington. U.S. Government Printing 

Office, 1976. 

6Mizrahi, A.: Micro-Economic de la Consummation Medicale. 

Paris. Centre de Recherche pour L’Etude et L’Observation des 

Conditions de Vie, Juillet 1978. 

‘National Center for Health Statistics: Health, United States, 

2978. DHEW Pub. No. (PHS) 78-1232. Public Health Service. 

Washington. U.S. Government Printing Office, Dec. 1978. 

8Davis, K., and Sheen, C.: Health and the War on Poverty. 

Brookings Studies in Social Economics. Washington. Brookings 

Institution, 1978. 

9Mizrahi, A., and Mizrahi, A.: Quelques Donn& Rkcentes sur la 

Concentration desD.+pense M4dicaks. Paris. Centre de Recherche 

pour L’l%ude et L’Observation des Conditions de Vie, Mar. 1979. 

10Andersen, R., Lion, J., and Anderson, O.: Two Decades of 

Health Services: Social Survey llends in Use and Expenditure. 

Cambridge, Mass. Ballinger Pub. Co., 1976. 

1lGibson, R. M,: National health expenditures, 1978. Health 

Care Financ, Rev. 1(1): Summer, 1979. And staff communication. 

pp. 1-36. 

121nstitut National de la Statistique et des Etudes ~conomiques, 

Ministixe de la Sant6 et de la Famine, et Centre de Recherche pour 

L’~tude et L’Observation des Conditions de Vie: Les Comptes 

de la Sant& Mt!thodes et Stiries, 1950-1977. Paris. Centre de 

Recherche pour L’~tude et L’Observation des Conditions de Vie, 

Juin 1979. 

13Duriez, M., Clapier, P., et Matthys, M.: Comptes Nationaux 

de la SantL’ La Consummation M@dicale Finale, 1977-1978, 

(Evaluation Provisoire). Paris. Centre de Recherche pour L’Etude 

et L’Observation des Condhions de Vie, Fr%rier 1979. 

14Lenoir, C., and Sandier, S.: La Consummation Pharmaceutique 

en France et aux U.S.A. Paris. Centre de Recherches et de 

Documentation sur la Consommation, Juin 1976. 

15U.S. Bureau of the Census: Statistical Abstract of the United 

States, 1978. 99th ed. Washington. U.S. Government Printing 

Office, 1978. 

16Mi~st&re de la s~tg et de la S6curit6 Sociale: tint~ S&CZ.frit@ 

Sociale: Statistique et Commentaires. Various issues. 

17American Hospital Association: Hospital Statistics. 1978 ed. 

Chicago. American Hospital Association, 1978. 

18National Center for Health Statistics, A. Zappalo: Characteristics, social contacts, and activities of nursing home residents, 

United States, 1973-74 National Nursing Home Survey. Vital and 

Health Statistics. Series 13-No. 27. DHEW Pub. No. (HRA) 

77-1778. Health Resources Administration. Washington. U.S. 

Government Printing Office, May 1977. 

19National Center for Health Statistics, C. M. Croner: Health 

Resources Statistim, 1976-77. DHEW Pub. No. (PHS) 79-1509. 

Public Health Service. Washington. U.S. Government Printing 

Office, 1979. p. 329. 

20Faure, H., and Sandier, S.: L’Evolution des Cot2ts Hospita[iers: 

H<pitaux Publics, 1965-1977. Paris. Centre de Recherche pour 

L’Etude et L’Observation des Conditions de Vie, Nov. 1978. 

21Russell, L. B.: Technology in Hospitals—Medical Advances 

and Their Diffusion. Brookings Studies in Social Economics. 

Washington. Brookings Institution, 1979. 

22American Hospital Association: Statement on rising herdth care 

costs, Council on Wage and Price Stability, Miami, Ott. 28, 1976. 

23American Hospital Association: Administrative reviews, a special issue. Hospitals. 53(7), Apr. 1, 1979. 

24Feldstein, M., and Taylor, A.: The Rapid Rise of Hospital 

Costs. Staff report. Executive Office of the President, Council on 

Wage and Price Stability. Washington, Jan. 1977. 

25Hu, T. W., ed.: International Health Costs and Expenditures. 

DHEW Pub. No. (NIH) 76-1067. National Institutes of Health. 

Washington. U.S. Government Printing Office, 1976. 

26American Medical Association: Reference Data on Socioeconomic Issues of Health, 1978. J. L. Wema and J. R. Leopold, ed. 

Chicago. American Medical Association, 1978. 

27American Medical Association: Reference Data on the Profiles 

of Medical Practice, 1978. J. Go ffney, ed. Chicago. American 

Medical Association, 1978. 

41

I

28Fuare, H., and Sandier, S.: Changes in Hospital Activity and 

Related Costs. Communication to the 21st International Hospital 

Congress. Oslo, Norway. June 24-29, 1979. 

29Gibson, R. M., and Fisher, C. R.: National health expenditures, 

fiscal year 1977. Sot. Secur. Bull. 41(7):3-20, July 1978. 

301nstitut National de la Statistique et des Etudes ficonomiques: 

Annuaire Statistique de la France. Paris. Institut National de la 

Statistique et des I%udes ficonomique, various years. 

31Institut National D’fitudes D6mographiques: Rapport sur la 

situation dimographique de la France. Population. Various years. 

32Klarman, H., Rice, D., Cooper, B., and Stetler, L.: Sources of 

Increase in Selected Medical Care Expenditures, 1929-1969. U.S. 

DHEW SSA - ORSSTAFF Paper No. 4, Apr. 1970. 

33Lebart, L., Sandier, S., and Tonnellier, F.: Aspects gdographiques 

du syst~me des soins m~dicaux. Consummation. No. 4, 1974. 

34Lebart, L., Sandier, S., and Tonnellier, F.: Geographic Aspects of 

the Medical Care System. Consummation, No. 4, 1974. 

35Minist?re de la Santd et de la S6curit& Sociale: Annuaire des 

Statistiques Sanitaires et Socia[es. Paris. Minist&e de la Sant6 et 

de la S&curit&Sociale, various years. 

36R&ch, G., and DNision d’ Economic M&dicale du Centre de 

Recherche pour L’l%ude et L’Observation des Conditions de Vie: 

Ek!ments de ‘Wconornique Mtidica[e.” Paris. Editions Flammarion, 1973. 

37Sandier, S,: L’6volution des d6penses m~dicales, Droit Social, 

Special issue No. 9-10, Sept.-Ott. 1978. 

42 
I 

Bibliography 

American Medical Association, Center for Health Services Research and Development, J. L, Werna and J. R. Leopold: Social 

Economic Issues of Health, 1978, 

fknerican Medical Association, Center for Health Services Research and Development, J. Go ffney, ed.: Profile of Medical 

Practice, 1978 (rev,). 

Faure, H., and Sandier, S.: Changes in Hospital Activity and 

Related Costs. Communication to the 21st International Hospital 

Congress. Oslo, June 24-29, 1979. 

I,N.E.D.: The demographic status of France. Revue Population. 

I.N. S.E, E.: Annuaires Statistiques. 

Klarman, H., Rice, D., Cooper, B., and Stetler, L.: Sources of 

Increase in Selected Medical Care Expenditures, 1929-1969. 

DHEW SSA – ORSSTAFF Paper No. 4, Apr. 1970. 

Lebart, L., Sandier, S., and Tonnellier, F.: Geographic aspects of 

the medical care system. Consummation. No. 4, 1974. 

Ministry of Health and Social Security: Annuaires .Watistiques des 

personnek, statirtiques hospitali$res. 

Rosch, G., and the Division of Medical Economics at CREDOC: 

Elements of medical economics. Flammarion. 1973. 

Sandier, S.: The growth in medical expenditures. Droit Social. 

Special issue, Sept. 9-10, 1978. 

Social Security Administration, R. Gibson and C. Fisher: National 

health expenditure, fiscal year 1977. Social Security Bulletin. 

4(7), July 1978. 

Statement of the American Hospital Association on Rising Health 

Care Costs Before the Council on Wage and Price Stability. Miami, 

Oct. 23, 1976. 

43 
I 

List of detailed tables 

1.	 8irth rate, crude death rate, and infant mortality rate France and 

United States, 1950-78 .................................................................. 

2,	 Life expectancy at birth, by sex France and United Stetes, 

19m.77 .......................................................................................... 

3.	 Population, per capita gross nationel product (GNP) in terms of 

current prices at the exchange rate of a given year, and general 

price index France and United States, 1950-78 ............................ 

4.	 Total medical care expenditures in current prices, by type of 

financing: France, 1950.76 ............................................................. 

5.	 Per capita medical expenditures in current prices United States, 

19W.78 .......................................................................................... 

6.	 Per capita medical care expenditurea in current prices, by type of 

services and goods France, 1950-78 .,,,,..,,,,.., ,,..,,......................... 

7.	 Medical care price indax, by type of services and goodx United 

States, 1950.78 .............................................................................. 

8.	 Medical care price index, by type of services and goods France, 

1950-78 .......................................................................................... 

9.	 Per capita medical care expenditures in relative values, by type of 

services and goods United States, 1950-78 .................................. 

10.	 Per capita medical care expenditures in relative values, by type of 

services and good= France, 1950.78 ............................................. 

11.	 Per capita medical care expenditurea in constant prices, by type 

of services and goods United States, 1950–78 .............................. 

12.	 Per capita medical care expenditurea in constant prices, by type 

of services and goods France, 1950-78 ......................................... 

13.	 Relative price index for medical care, by type of services and 

goods, with the general price index United States, 1950-78, ....... 

14.	 Relative price index for medical care, by type of services and 

goods, with the general price index: France, 1950-78. .................. 

15.	 Per capita medical care expenditures in current value, by type of 

financing: France and United States, 1950-76 ...,,,..,.........,..,,,..,.,.. 

16.	 Average annual rate of increase of nominal value of per capita 

medical care expenditures, by services and goodx France and 

United States, selected periods during 1950-78 ............................ 

17.	 Average annual rate of increase of nominal price indexes for 

medical care, by services and goods France and United States, 

selected periods during 1950.78 .................................................... 

18.	 Average annual rate of increase of per capita medical care expenditures in relative value and constant prices, by services and 

goods France and United States, 1950-78, ................................... 

19.	 Average annual rate of increase of medical care prices relative to 

the general price index, by type of services and goods France 

and United States, selected periods during 1950-78 ..................... 

20.	 Nominal price index and relative price index of a hospital da~ 

France and United States, 1950.78 ................................................ 
---

--- ---

--- ---

--- ---

--- --- ---

--- --- ---

--- ---

--- --- ---

--- --- ---

---

Table 1. 8irth rate, crude death rate, and infant mortality rat= France and United States, 1950-78 

Bitih rate Crude death rate Infant mortality ratel 

Year 

France United States France United States France’ United States 

1950 ........m ...................m ............................

1951 .......m ..............................m ..................

1952 ......................................................... 

1W ,!.,,..,,,,,.,,,..,,., ,,,,.,,,,,,.,,,,!,,,., ,,,,,,...,,,. 

19M ....m.................................................... 

1955 .............m........................................... 

1956 ......................................................... 

1957 ......................................................... 

1958 ,,,.,,..,.,,,,,,,,,,.,,,,.,,,,.,.,.,,,,.,. .,..,,,,,,,.... 

19m ......m.................................................. 

1960 ......................................................... 

1961 ......................................................... 

1962 ......................................................... 

19m ...............m......................................... 

19M .....................................................m... 

1965 ......................................................... 

1966 ......................................................... 

1967 ......................................................... 

1968 ,,,,,,.,,.,,,,,,.,,,.,,,,,,,,.,.,,.,.,,,., ............... 

1969 ......................................................... 

1970 ......................................................... 

1971 ......................................................... 

1972 ......................................................... 

l973.,.,.,,,,,.,,,,,,,,,,,..,.,,,,,,.,,...,,,.,,,,,..,,..,,., 

1974..o...............mm ........m ............................

1975,,,,,.,.,,,,,,., ......................................... 

1976 ......................................................... 

1977,..,,,,,,,,..,,..,,, s,,...,,,,,,......................... 

1978 ,,.,,..,.., ,,.,,,.,,,,..,,.,,,..., ,,..,,................. 

Number of births per 

1,000 population 

20.7 24.1 

19.7 .-. 

19,4 ..-

18,9 . . . 

18.9 -.. 

18.7 25.0 

18.5 

18.5 

18.2 .-. 

18.4 

18.1 23.7 

18.3 

17.9 22.4 

18.3 21.7 

18.3 21,0 

17.8 19.4 

17.6 18.4 

17.0 17.8 

16.8 17.5 

16.8 17.5 

16.8 18.4 

17.3 17.2 

17.1 15.6 

16.5 14.9 

15.3 14.9 

14.1 14.8 

13.6 14.8 

14.0 15.3 

Number of deaths of infants 

Number of deaths per under 1 year of age per 

1,000 population 1,000 live births 

12.8 9.6 51.9 29.2 

13.5 .-. 50.2 

12.4 45.1 

13.1 41.7 

12.1 40.8 

12.2 9.3 38.6 26.4 

12.5 36.2 

12.1 33.8 

11.2 31.5 

11.3 28.6 

11.5 9.5 27.4 26.0 

10.9 25.7 

11.6 9.5 25.7 25.3 

11.7 9.6 25.6 25.2 

10.8 9.4 23.4 24.8 

11.2 9.4 21.9 24.7 

10.8 9.5 21.7 23.7 

11.0 9.4 20.7 22.4 

11.1 9.7 20.4 21.8 

11.4 9.5 19.6 20.7 

10.7 9.5 18.2 20.0 

10.9 9.3 17.2 19.1 

10.7 9.4 16.0 18.5 

10.8 9.4 15.4 17.7 

10.6 9.2 14.5 16.7 

10.6 8.9 13.6 16.1 

10.5 8.9 12.5 15.2 

10.1 11.5 14.1 

13.8 15.3 10.2 E 10.6 13.6 

1Corr@ed Infant ~otiality rate ~nclu~ng infants born alive who died bsfore they were registered in civil records).


SOURCES: National Institute of Statistics and Economic Resaarch, Paris and Nstional Center for Health Statiatim Sretistice/ Arsrract, Washington, U.S. Government Printing


Office,1978. 

Table 2. 

Ymr 

1960 ,,,,.,.,,,,,.,.,,,,,., ,,,!.,,.,,,,.., ...,,.................. 

1960 ..................,,,,...................................... 

1961 ............................................................ 

1962 .................,.,.,.,,................................... 

19m ............................................................ 

1964 .,,,,.,,,..,,..,,.,.,,..., ,,,,,..,.,,.,,,,.................. 

1965 ,,...,..,. ,.,.......O....................................... 

1966 ........................................o................... 

1967 ............................................................ 

1968 ...............................................o.........o.. 

1969 .............................................o.............. 

1970 ....,.,,,..,,.,., ,,..,...................................... 

1971 ............................................................ 

1972 ......,,..,................................................. 

1973 ....................o....................o.................. 

1974 ......m.....................................................


1975 .,,.,,,,,.,,,..,,,,, ,,,,.,.,,,.,,,..,,.. ,,,,.. ,,,.,,,.......


1976 ............................................................


1977 ,.,,,,,,,,,.,,,.,,,,, ,!,,,,,,,,,.,,,,,.,. ................... 

Life expectancy at birth, by sex France and United States, 1950-77 

France United States 

Men Women Men Women 

Life expectancy (in years) 

63.4 69.1 65.6 71.1 

67.3 73.9 66.6 73.1 

67.5 74.3 67.0 73.6 

67.0 73.9 66.8 73.4 

66.8 73.8 66.6 73.4 

67,7 74.8 66.9 73.7 

67.4 74.6 66.8 73.7 

67.7 75.1 66.7 73.8 

67.5 75.1 67.0 74.2 

67.7 75.2 66.6 74.0 

67.4 75.1 66.8 74.3 

68.6 76.0 67.1 74.8 

68.5 76.1 67.4 75.0 

68.7 76.4 .-. 

68.9 76.5 67.6 75.3 

68.9 76.9 66.2 75.9 

69.1 76.9 68.7 76.5 

69.2 77.2 69.0 76.7 

69.71 77.9 69.3 77.1 

SOURCES National Institute of Statistics and Economic Research, Paris; and National Center for Health Statistics, Hyattsville, Md. 

45 
Table 3. Population, per capita 

R3pulation 

in thousands 

Y3ar 

United France States 

1950 ...................... 41,829 151,900 

1955 ...................... 43,428 165,100 

1980 ...................... 45,664 180,000 

1961 ...................... 46,163 163,000 

1962 ...................... 46,998 185,800 

1963..,.,,,.., ............ 47,816 168,500 

1984 ...................... 48,310 191,100 

1965 ...................... 48,758 193,500 

1966 ...................... 49,184 195,600 

1967..., .................. 49,546 197,500 

1968 ...................... 49,915 189,400 

1969 ...................... 50,318 201,400 

1970 ...................... 50,766 203,800 

1971 ...................... 51,248 208,200 

1972 ...................... 51,703 208,200 

1973 ...................... 52,118 209,900 

1974..,., ................. 52,460 211,400 

1975 ...................... 52,705 213,100 

1976.., ................... 52,891 214,700 

1977 ...................... 53,078 216,300 

1978...,,,,., ............. 53,278 217,250 

‘Gross national product. 

2Produit Int.%eur Brut. 

gross national product (GNP) in terms of current prices at the exchange rate of a given year, 

and general price index France and United States, 1950-78 

Per capita GNP in current currency Exchange General price index 

rate (1967 = 100)

France2 United Statesl 

1 percent Fiance United I 

Dollars Francs Dollars Francs = Francs States 

670.86 2,341,30 1,341.22 6,436.91 3,4968 45.3 72.1 

1,113.50 3,686,13 2,450.00 8,754.27 3.4697 59.9 60.2 

1,323.59 6,490.24 2,747.95 13,474.57 4.9039 78.8 88,7 

1,430.60 7,010.00 2,842.07 13,926.14 4.9039 81.3 68.8 

1,569.40 7,690.00 3,015.60 14,776.40 4.9003 85.3 90.6 

1,728.10 8,488.00 3,131.56 15,334.84 4.8003 68.4 91.7 

1,697.60 9,298.30 3,309,28 16,215.37 4,9005 92.5 92.9 

2,023.20 9,918.07 3,556.07 17,444.00 4.9012 84.7 94,5 

2,168.20 10,646.00 3,640.60 18,903.50 4.9136 97.3 97.2 

2,319.30 11,411.15 4,031.69 19,827.60 4.9200 100.0 100.0 

2,467.00 12,310.80 4,355.60 21,582.00 4.9513 104,5 104.2 

2,683.10 13,925.40 4,645.00 24,081.60 5.1991 111.2 109.8 

2,792.20 15,413.25 4,714.01 26,021.34 5.5282 117.0 116.3 

3,089.70 17,024.70 5,180.00 28,431.60 5.5118 123.4 121.3 

3,765.00 18,975.60 5,624.40 28,324.80 5.0446 131.1 125.3 

4,804.14 21,378.41 6,107.32 27,202.00 4.4540 140,7 133,1 

5,070.45 24,367.10 6,680.00 32,084.00 4.8057 160,0 147,7 

6,423.10 27,555.20 7,170.00 30,759.30 4.2954 178.8 161.2 

6,628.80 31,619.70 7,751.69 37,049.98 4.7796 196.0 170.5 

7,195.30 35,329.10 8,720.00 42,815.20 4.9133 214,4 181,5 

8,857.00 39,945.19 9,451.12 42,624.50 4.5117 233.9 195.4 

Table 4. Total medical care expenditures in current prices, by type of financing: France, 1950-76 

tiblic, central and local governments 

Mutual Rivata financing Total final 

Year Social Madical insurance (households madical security Medical 

assistance assistance Total companies and private consumption 

to veterans insurance) 

Francs 

1950 ....................................... 1,300 380 34 414 146 1,078 2,938 

1951 ....................................... 1,722 442 45 487 191 1,468 3,868 

1952 ....................................... 2,201 50 687 239 2,031 5,413 

1953 ....................................... 2,432 z 55 687 263 2,031 5,413 

1954 ....................................... 2,688 673 58 729 290 2,231 5,938 

1955 ....................................... 2,985 716 63 779 315 2,473 6,552 

1956 ....................................... 3,462 631 85 916 366 2,865 7,509 

1957 ....................................... 3,932 986 85 1,053 408 3,101 8,494 

1958 ....................................... 4,524 1,043 97 1,140 483 3,698 9,825 

1958 ....................................... 4,705 933 117 1,050 496 4,390 10,841 

1960 ....................................... 5,672 917 142 1,059 646 4,631 11,908 

1961 ....................................... 7,184 956 120 1,078 600 4,943 13,785 

1962 ....................................... 8,640 1,121 174 1,294 630 5,100 15,864 

1963 ....................................... 10,635 1,446 182 1,628 661 5,554 18,478 

1984 ....................................... 12,732 1,596 186 1,782 673 6,286 21,473 

1965 ....................................... 14,268 1,568 197 1,785 773 7,070 23,696 

1966 ....................................... 16,416 1,831 220 1,851 870 7,878 27,015 

1967 ....................................... 18,483 1,666 218 1,864 974 8,626 29,967 

1986 ....................................... 19,413 1,730 236 1,960 1,202 9,424 32,007 

1969 ....................................... 24,624 1,790 274 2,084 1,369 10,567 38,844 

1970, ...................................... 29,145 1,687 325 2,212 1,570 11,363 44,290 

1971 ....................................... 33,818 1,913 2,257 1,733 13,068 50,876 

1972 ....................................... 36,991 2,115 360 2,475 2,193 14,087 57,746 

1973 ....................................... 44,858 2,283 397 2,680 2,338 16,276 66,152 

1974 ....................................... 52,949 2,432 2,883 2,812 19,418 78,042 

1975 ....................................... 68,006 2,792 &6 3,248 3,425 22,545 97,224 

1976 ....................................... 80,906 3,140 46a 3;628 4,218 24,908 113;660 

NOTES Exchange rate 1 dollar= 4.78 francs in 1976. Figures may not add to totals due to rounding. 

SOURCE National Health Statistics, Compt6s Nationaux da la Sant6, Paris. 

46 
---

--- ---

---

Table 5. Per capita medical expenditures in current prices United States, 1950-78 

Hospital 

homes services appliances 

Total nursing services goods services 

care 

1 2 3 4 5 6 7 T A B c D 

Dollars 

1950,,,,, 24.90 1.21 17.76 2.56 6.21 11.16 3.17 70.37 26.11 26.53 14.33 3.40 

1960 ..... 49,46 2.86 30.92 4.69 10.75 19.89 4.22 128.81 52.32 46.36 24.11 6.02 

1965,.,,, 70.46 10.48 42.85 5.22 14.20 29.18 9.44 1&3.42 80.84 62.27 38.62 6.59 

1966, - 78,18 12.28 45.86 5.80 14.82 30.40 10.45 205.22 90.46 66.48 40.85 7.43 

1967 ..... 90.28 14.28 50.15 6.22 16.61 31.72 9.63 227.07 104.56 72.98 41.55 7.98 

1968..,., 102,88 16.56 54.36 6.97 17.98 34.48 10.58 252.32 119.44 79.31 45.06 8.51 

1969..,.. 116.44 18.57 61.31 7.13 20.35 37.20 10.51 280.63 135.01 88.79 47.71 9.12 

1970 ..... 133,39 22.44 68.81 7.65 22.79 40.33 10.07 315.25 155,63 99.25 50.40 9.77 

1971,,... 146.14 26.74 75.60 7.73 24.07 41.54 9.67 342.52 172.88 107.40 51.21 11.03 

1972 ..... 184.71 28.97 80.82 8.46 26.48 44.00 10.33 376.14 193.68 115.79 54.33 12.34 

1973.,.,, 180.35 33.13 89.16 9.22 30.52 46.98 11.59 413.53 213.48 128.90 58.57 12.56 

1974.,,,, 207.97 38.73 98.49 10.34 34.15 51.17 12.55 467.72 246.70 142.98 83.72 14.32 

1975,.,.. 239.77 45.46 114,66 12.04 37.88 54.32 13.71 534.82 285.23 184.58 86.03 16.98 

1976..,,, 272,69 52.22 126,11 14.60 46.19 58.40 14.60 602.45 324.91 186.90 73.00 17.84 

1977.,... 307.13 60.44 141,29 16.73 52.69 62.45 15.62 674.46 367.57 210.71 78.07 18.11 

1978, .... 340.93 70.84 158.08 19.17 59.84 67.70 17.40 752.98 411.57 236.89 85.10 19.42 

NOTE T= A+ B+ Ci. D, A=l+2, B=3+4+5, and C=6+7. 

Other Eyeglasses and Medical Medical m~’,~a, Yeer Hospitals Nursing I+rysicians professional Dentists Pharmacy and 

home 

SOURCE Haalth CareFinancingAdministration, Baltimore. 

Table6. Percapita medical care expenditures uncurrent prices, by~peof aewices and goods France,1950-78 

Medical Hospital care to Eyeglasses Total and 

Year Physicians Dentists Assistants Laboratories 13’rarmacy and medical nursing ambulatory Medical 

patients goods appliances care home and home carel care 

1 2 3 4 5 6 T A B c 

Francs 

1950,,...,.,,, ..... . . . . . . -.. .-. 70.24 26.87 23.06 20.34 

1955 ............... ..- . . . ..- .-. 150.87 48.24 53.84 48.79 

1960,, ............. 48.80 29.00 4.44 4.27 68.93 6.90 260.66 84.91 89.92 75.83 

1961 ............... 47.96 34.40 4.84 4.79 85.05 7.43 298.62 111.45 84.88 92.46 

1962..., ........... 51.51 39.28 5,92 5.83 95.34 8.26 337.55 128.60 105.34 103.80 

1963 ............... 62.70 42.85 7.34 7.07 105.49 8.95 386.44 148.99 121.97 114.44 

1984,,..,, ......... 73,53 52.14 8.55 8.38 119.00 9.58 44448 169.74 146.16 128.58 

1965,, ............. 79.80 55.72 10.73 9.84 133.52 10.15 490.09 186.72 159.71 143.67 

1966 ............... 93.77 60.15 14.42 11.47 150$8 10,74 549.49 203.63 184.04 161.62 

1967 ............... 103.37 66.22 16.63 14.48 167.39 11.34 604.81 220.80 205.28 178.74 

1968.., ............ 110.63 68.92 17.75 14.64 177.90 11.76 841.23 224.44 217.13 189.66 

1969.,..,, ......... 130.57 79.32 21.23 17.27 208.26 12.84 788.00 293.25 253.65 221.08 

1970 ............... 143!10 85.80 26.24 19.86 236.37 16.78 872.40 336.83 280.79 253.15 

1971 ,,,.,,,,,,.,!,. 160.00 95.57 29.62 23.92 284.10 17.78 992.57 388.20 315.85 281.88 

1972.,,,..,,,..,,.. 179.91 107.23 36.48 27.68 290.06 19.40 1,116.88 443.09 358.41 309.46 

1973, .............. 207.40 127.05 43.56 31.41 321.85 20.88 1,269.38 504.90 417.44 342.76 

1974 .,............. 236.50 145.48 51.51 37.42 365.73 25.87 1,487.41 616.52 480.20 384.16 

1975,.,,..,.,.,,,.. 287.13 170.38 62.80 47.04 426.84 34.34 1,844.66 798.20 578.29 461.28 

1976..,,,,, ........ 329.34 189.65 74.72 55.68 444.22 37.72 2,148.95 999.32 659.30 481.76 

1977.., ............ 358.11 222.99 82.82 62.27 458.70 41.26 2,409.89 1,161.80 740.58 489.88 

1978,...,,,,..-. 414.07 275.48 94.20 75.68 541.07 46.98 2,841.84 1,371.97 875.99 588.02 

lExclude~nursin9 homeein Franc@. 

NOTES Exchangeratwl doller= 4.5117 francain 1978. Figuresmaynotadd tototala dueto rounding. 

SOURCE Centrede Recherche pour L’&tudeet L’Obaervation des Conditions de Vie, Paris. 

47 
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Table7. Medical care price index, bytypeof services and goods United Statea,1950-78 

Medical 

cost Hospital cara to 

of Other Eyeglasses Total and 

Y@ar hospital Physicians professional Dantists Pharmacy and medical nursing ambulatory Medical 

patients goods services appliances care home care and home care care 

1 2 3 4 5 6 T A B c 

Dollars 

1950 .................... 51.0 55.2 . . . 63.9 68.5 73.5 58.4 51.0 59.0 84.2 

1960 .................... 78.3 77.0 82.1 104.5 85.1 81.7 78.3 79.6 101.3 

1965 .................... 93.1 6a.3 84.8 92,2 100.2 92.8 93.3 93.1 88.4 97.7 

1966 .................... 94.4 93.4 96,8 95,2 100.5 95,3 95,5 84.4 94.0 98.3 

1967 .................... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

1968 .................... 107.5 105.6 103.5 105.5 100.2 103.2 105.7 107.5 105.5 101.1 

1969 .................... 116.0 112.9 107.5 112.9 101.3 107.6 112.5 116.0 112.4 103.4 

1970 .................... 126.1 121.4 111.4 119.4 103.6 113.5 120.4 126.1 120.1 107.0 

1971 .................... 134.1 129.8 116.1 127.0 105.4 120.3 127.2 134.1 127.8 110,0 

1972 .................... 138.6 133.8 120.4 132.3 105.6 124.9 131.0 138.6 132.2 111.0 

1973 .................... 145.4 138.2 122.8 136.4 105.9 129.5 135.9 145.4 136.5 112.0 

1974 .................... 158.8 150.9 135.4 146.8 105.9 138.6 146.9 158.8 148.8 113.6 

1975 .................... 177.9 169.4 151.4 161.9 109.6 149.6 162.8 177.9 166.2 118.5 

1976 .................... 196.0 188.5 160.5 172.2 118,8 158.9 178.7 196.0 182.9 128.0 

1977 .................... 213.8 206.0 169.4 185.1 126.0 166.2 194.0 213.8 198.6 135.7 

1978 .................... 229.9 233.1 176.2 198.1 134.1 174.4 210.3 229.9 220.3 143.6 

NOTES 19601ndexes =lOO. ~eptice indexes corresponding toaggregates T, A, B,and Care implicit price indexes. 

SOURCES Consumer Pticelndex, andthe Ametican Hospital Aswciation, CMcago. 

1 2 3 4 5 6 T A B c 

Francs 

Table8. Medical care price index, bytypeof aervices and goods France,1950-78 

Medical Hospital cara to Eyeglasses Total and 

Year Physicians Dentists Assistants Laboratories Pharmacy and medical nursing ambulatory Medical 

patients goods appliances cara home and home care’1 care 

1950 ............... -.. -.. . . . -.. 51.30 54.19 38.98 75.87 

1955 ............... . . . . . . . . . ..- . . . 76.30 71.27 70.02 96.81 

1960 ............... 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 

1961 ............... 84.60 96.50 103.50 100.00 101.60 103.40 102.80 105.66 96.70 102.00 

1962 ............... 102.30 102.40 108.40 100.00 104.30 107.50 108.70 113.12 103.60 104.90 

1963 ............... 110.70 109.60 110.50 123.30 104.00 111.50 116.40 126.13 111.60 105.00 

1984 ............... 122.20 116.00 110.50 125.00 104.20 115.20 122.00 132.92 120.40 105.50 

1965 ............... 126.90 120.90 112.60 125.00 104.30 120.00 124.70 135.52 124.90 106.00 

1966 ............... 135.30 126.60 116.10 131.70 104.70 124.30 129.10 140.16 131.60 106.70 

1967 ............... 141.60 132.10 119.90 141.70 104.80 126.20 132.20 144.57 137.90 106.90 

1968 ............... 153.00 135.80 122,40 141,70 104.10 133.00 138.00 152.63 145.20 106.60 

1969 ............... 170.00 148.10 133.90 141.70 108.30 137.10 150.00 170.93 158.80 110.60 

1970 ............... 176.40 154.00 141.30 148.30 110.50 137.30 156.40 181.67 165.40 112.90 

1971 ............... 168.00 163.70 146.10 157.30 110.10 145.80 164.20 195.93 175.70 113.00 

1972 ............... 203,20 172.30 157.30 157.30 111.70 151.10 172.30 208.26 166,60 114.70 

1973 ............... 223.40 191,90 170,40 157.30 111.10 152.90 163.20 227.63 204,10 114.20 

1974 ............... 239.10 221.10 179.80 171.10 116.70 167.40 199.20 251.81 223.30 120.30 

1975 ............... 273.60 241.80 200.10 180.70 123.90 178.60 233.70 284.23 249.20 127,90 

1976 ............... 302.60 260.70 216.10 190.80 126.50 184.90 246.60 337.10 271.20 130.80 

1977 ............... 324.10 295.10 236.40 195.40 130.50 196.10 266.40 366.74 284.50 135.30 

1978 ............... 355,00 334.00 256.90 205.50 144.30 216,30 293.30 402,83 323,70 149.50 

‘Excludaa nursing homesin Frence. 

NOTES 19601ndexes =lW. ~eptice indexes mrrespondng toaggrqates T, A, B,and Care implicit price indexes. 

SOURCES: National Institute of Statistics and Economic Research, Paris, snd Centrede Recherche pour l-’~tudeet L’Observationdes Conditions de Vie, Peris. 

48 
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Table9. Parcapita medical care ex~enditures inrelativevaluesj bytypeof services and goods United States,1950-78 

Hospitals 

1 

1950 ..... 67.46 

1960,,,,. 108,93 

1965,,,.. 145.65 

1966 .,,,. 157.12 

1967 ..... 176.36 

1968,,... 192.88 

1969 ..... 207.16 

1970,.,.. 224.06 

1971 .,,,, 235.35 

1972..,,, 256.79 

1973.,... 264,70 

1974, .... 275.06 

1975.,,,, 290.56 

1976..,.. 312.43 

1977 ..... 330.57 

1978,,,,, 340.84 

Other Eyeglasses Hospital and Nursing Physicians professional Dentists Pharmacy and Total nursing home Medical Medical 

homes services appliances care goods 

2 3 4 5 6 7 T A B c 

Dollars 

3.28 48.12 6.94 16.63 30.24 8.59 190.70 70.60 71.80 38.80 

6.30 68.10 10.33 23.68 43.81 9.29 263.80 115.30 102.10 53.10 

21.66 88.58 10.79 29.35 60.32 19!51 368.60 167.40 128.80 79.90 

24.68 92.17 11.66 29.78 61.10 21.00 412.60 181.90 133.6o 82.10 

27.90 97.97 12.15 32.45 61.97 19.20 443.70 204.30 142.60 81.20 

31.05 101.91 13.07 33.71 64.64 19.63 473.20 224.00 148.70 

33S34 109.08 12.69 36.21 66.18 18.70 489.40 240.30 156.00 E: 

37.69 115.58 12.85 38.28 67.74 16.91 529.70 261.80 166.80 64.70 

43.06 121.75 12.45 38.76 66.90 15.57 551.80 278.50 173.00 82.50 

45.17 126.00 13.22 41.30 68.60 16.11 586.60 302.00 180.60 64.70 

48.62 130.86 13.53 44.79 68.95 17.01 607.10 313.40 188.20 66.00 

51,22 130.26 13.68 45.17 67.68 16.60 618.80 326.40 189.20 64.30 

55.09 138.95 14.59 45.90 65.63 16.61 646.30 345.70 199.50 82,60 

59.83 144.49 16.73 52.92 66.91 16.73 690.40 372.40 214.20 63.70 

65.05 152.07 18.01 56.71 67.22 16.81 726.10 395.70 226.60 64.00 

70.62 158.04 19.17 59.62 67.68 17.40 753.00 411.60 236.90 85.10 

1Nominal VaIue deflsted by the general price index. 

NOTE Figures may not add to totals due to rounding. 

Table 10. Per capita medical care expenditures in relative values) by type of services and goods France, 1950-78 

Medical Hospital care to Eyeglasses Total and 

Ymr t%ysicians Dentists Assistants Laboratories Pharmacy and medical nursing ambulatory Madical 

patients goods appliances care home and home carez care 

1 2 3 4 5 6 T A B c 

Francs 

1950,,.,, .......... .-. 362.36 138.63 118.77 104.86 

1955 ............... . . . . . . -.. 597.34 191.00 213.16 193.19 

1960., ............. 147,91 86,14 13.19 12.68 204.73 20.48 774.18 281.90 267.07 225.21 

1961 ............... 137,92 98.92 14.21 13.77 244.57 21.37 858.73 320.50 272.29 265.93 

1962 ............... 141,28 107.73 16.24 15.99 261.50 22.64 925.78 352.71 298.98 284.14 

1963 ............... 164.03 112.11 19.20 18.50 275.97 23.42 1,010.97 388.77 319.08 299.38 

1964, .............. 165.94 131.86 21.62 21.19 300.95 24.24 1,124.06 429.25 369.63 325.18 

1965 ............... 196,99 137.55 26.48 23.80 328.58 25.06 1,209.76 460.90 384.22 354.63 

1966...,.,,,...,... 225.31 144.52 34.65 27.56 362.55 25.81 1,320.36 469.78 442.22 366.36 

1967,,,...,,,,, s,,, 241.86 154.93 38.91 33.90 391.65 26.54 1,415.06 516.59 480.28 418.18 

1968 .,............. 247.61 154.25 39.73 32.77 398.18 26.32 1,435.19 524.72 465.97 424.50 

1969,,,.,.,,.,,,,.. 274.61 164.28 44.65 36.32 437.99 27.00 1,615.20 616.76 533.45 464.88 

1970, .............. 286,04 171.50 52.45 39.70 472.46 33.54 1,743.79 673.26 561.25 506.01 

1971,,, ............ 303.25 181.14 56.14 45.34 500.55 33.69 1,661.21 737.65 598.26 534.24 

1972,,.,,,,,,,,.,,, 321.05 191.35 65.10 49.40 517.61 34.62 1,993.07 790.69 639.58 552.23 

1973,,,,,,,,,,,,,,, 344.70 211.16 72.40 52.20 534.98 34.70 2,109.77 639.17 693.60 569.68 

1974,,.,...,,,.,,.. 345.74 212.67 75.30 54.70 538.16 38.06 2,189.04 901.29 702.00 576.22 

1975,,,..,, ........ 375.67 222.93 82.17 61.55 558.61 44.93 2,413.55 1,044.36 756.64 603.54 

1976,,,,,,..,..,,., 393.03 226.33 89.17 66.45 529.53 45.40 2,564.52 1,192.57 786.60 574.93 

1977 ............... 390.68 243.27 90.35 67.93 500.41 45.01 2,629.01 1,267.44 607.93 545.42 

1978 ............... 414.07 275.48 84.20 75.88 541.07 46.98 2,841.64 1,371.97 875.99 588.05 

1Nominal Va[ua deflated by the gensral Pfice index. 

‘Excludes nursing homes in France. 

NOTES Exchsngerata 1 dollsr = 4.5117 francs in 1978. Figures may not add to totals due to rounding. 

49 
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Table 11. Per capita medical care expenditurea in constant pricea~ by type of services and goods United Statea, 1950-78 

Medical Hospital care to Other Total and 

Year Hospitals Nursing f%ysicians professional Dentists Rrarmacy 

Eyeglasses 

medical nursing ambulatory Medical and homes patients goods sewices appliances services home and home care care 

1 2 3 4 5 6 7 T A B c 

Dollars 

1950 ...... 112.25 5.45 75.00 .-. 19.25 16.91 7.52 253.50 117.70 99.04 24.43 

1960 ...... 145.22 8.40 93.60 ..- 25.84 25.52 8.65 331.60 153,62 128,29 34.17 

1865 ...... 173.99 25.88 113.12 9.70 30.51 39.05 17.74 425.00 199.87 153.40 56.79 

1966 ...... 190.40 29.91 114.45 10.56 30.84 40.58 19.12 452.30 220.30 155.85 59.66 

1967 ...... 207.55 32.83 116.90 10.96 32.90 42.54 17.14 477.80 240.38 160.76 59.68 

1868 ...... 220.02 35.42 119.99 11.87 33.76 46.15 17.66 502.10 255.43 165.62 64.03 

1969 ...... 230.77 36.80 126,56 11.68 35.71 49.25 17,03 525,00 267.58 173.98 66.28 

1970...... 243.19 40.91 132.12 12.10 37.81 52.20 15.47 551.00 284.10 182.03 67.67 

1971 ...... 250.54 45.84 135.77 11.73 37.55 52.85 14.02 566.70 296.38 185.05 66.87 

1972 ...... 273.21 48.05 140.80 12.41 39.66 55.87 14.42 604.40 321.26 192.87 70.29 

1973 ...... 285.16 52.38 150.38 13.23 44.33 59.48 15.61 640.20 337.55 207.84 75.10 

1974.,..., 301.09 56.07 152.14 13.46 46.08 64.60 15.79 670.10 357.16 211.68 80.59 

1975 ...... 309.85 56.75 157.78 14.01 46.35 66.46 15.98 691.30 368.60 218.14 82.44 

1976 ...... 319.85 61.25 155.95 16.03 53.14 65.92 16.02 709.10 381.11 225.12 81.84 

1977 ...... 330.26 54.99 159.66 17.40 56.39 66.46 16.20 731.20 395.25 233.67 82.66 

1978 ...... 340.93 70.64 158.08 19.17 59.64 67.70 17.40 753.00 411.57 236.68 85.10 

1Nominal value deflatedby the price index for health care, 

NOTE Figures may not add to totals dua to rounding. 

Table 12. Par capita medical care expenditurea in constant prices) by type of services and goodx France, 1950-78 

Medical Hospital care to Eyeglasses Total and 

Year Physicians Dentists Assistants Laboratories Pharmacy and medical nursing ambulatory Medical 

patients goods appliances care home and home care2 care 

1 2 3 4 5 6 T A B c 

Francs 

1950 ............... ..- 401.59 199.74 191.49 40.08 

1955 ............... ..- 579.95 272.65 248.90 75.34 

1960 ............... 176.79 96.86 11.41 8.77 99.47 14.92 735.19 382.30 291.07 113,37 

1961 ............... 179.98 119.06 12.26 9.64 120.79 15.54 852.00 424.68 316.97 135.55 

1962 ............... 178.75 128.12 14.03 11.98 131.90 16.62 910.79 457.91 329.14 147.65 

1963 ............... 201.07 130.58 17.06 11.78 146.37 17.36 973.74 475.60 353.15 162.84 

1954 ............... 213.61 150.13 19.88 13.78 164.80 17.99 1,068.57 514.38 392.96 182,22 

1965 ............... 223.24 153.93 24.46 15.85 164.73 18.30 1,152.71 554.98 413.92 202,63 

1966 ............... 246.03 158.69 31.91 17.90 207.95 18.69 1,248.38 565.79 452,00 226.45 

1967 ............... 259.16 167.43 35.63 21.01 230.48 19.44 1,335.77 615.19 461.65 249.97 

1968 ............... 256.69 169.51 37.25 21.23 246.60 19.13 1,362.85 617.90 484.06 265.99 

1869 ............... 272.66 178.89 40.73 34.93 277.49 20.26 1,501.70 691.06 516,72 298.31 

1970 ............... 287.98 186.09 47,71 27.52 308.67 26.43 1,636.03 746.60 549.53 335.22 

1971 ............... 302.13 184.99 51.38 31.25 346.14 26.36 1,772.96 600.14 561,54 372.93 

1972 ............... 314.31 207.86 59.58 36.16 374.71 27.77 1,901.22 857.00 621.06 403.35 

1973 ............... 329.57 221.13 65.67 41.03 418.03 29.54 2,032.26 682.66 662.05 448.71 

1974 ............... 351.14 219.77 73.60 44.84 452.23 33.43 2.204.77 986.20 696.11 489.63 

1975 ............... 372.56 235.35 60.63 53.50 487.24 41.59 2;315.10 1,092.73 751.17 539.18 

1976 ............... 386.37 242.97 68.83 46.56 506.73 44.13 2,555.91 1,184.07 766.93 550.64 

1977 ............... 382.25 252.38 90.00 65.49 507.21 45.51 2,653.23 1,276.03 814.02 552.43 

1978 ............... 414.07 275.48 84.20 75.68 541.07 46.98 2,641.64 1,371.87 875.99 588.02 

1Nominal value deflated by the price index for health ~re. 

z~cludes nursing homes in France. 

NOTES Exchange rate 1 dollar= 4.5117 francs in 1978. Figures may not add to totals due to rounding. 

50 
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Table 13. Relative mice indexl for medical care, by tvpe of services and goods, with the general price index United States, 1950-78 

Medical Hospital care to Other Eyeglasses Total and General cost Year of care Physicians professional Dentists Pharmacy and medical nursing ambulatory Medical price patients goods services appliances care home index and home care cara 

1 2 3 4 5 6 T A B c D 

Dollars 

1950.,,,,. 70.7 76.6 ..- 88.6 122.7 101.9 81.0 70.7 81.8 116.9 72.1 

1960 ...... 88.3 86.8 92.6 117.8 95.9 92.1 88.3 89.7 114.3 66.7 

1965., .... 98.5 93.4 100.3 97.6 106.0 98.2 98.7 98.5 94.6 103.4 84.5 

1966,.,.,, 97.1 96,1 99.6 97.9 103.4 98.0 98.2 97.1 96.7 101.2 97.2 

1967,,,,,. 100!0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 

1968.,,,.. 103.2 101.3 99.3 101.2 96.2 99.0 101.5 103.2 101.2 97.0 104.2 

1969 ...... 105,6 102.8 97.9 102.8 92.3 98.0 102.4 105.6 102.4 84.2 109.8 

1970 ...... 108.4 104.4 95.8 102.7 89.1 97.6 103.5 108.4 103.3 92.0 116.3 

1971 ,s,,,, 110.6 107,0 95.7 104.7 86.9 99.2 104.8 110.6 105.4 90.7 121.3 

1972...,., 110.6 106.8 96.1 105.6 84.3 99.7 104.5 110.6 105.5 88.6 125.3 

1973...,.. 109.2 103.8 92.3 102.5 79.6 97.3 102.1 109.2 102.6 84.2 133.1 

1974,, .... 107.5 102.2 91.7 99.4 71.7 93.8 99.4 107.5 100.7 76.9 147.7 

1975 ...... 110.4 105.1 93.9 100.4 68.0 92.8 101.0 110.4 103.1 73.5 161.2 

1976 ...... 115.0 110,6 94.1 101.0 69.7 93.2 104.8 115.0 107.3 75.1 170.5 

1977 ...... 117.8 113.5 93.3 102.0 69.4 92.7 106.9 117.8 109.4 74.7 181.5 

1978 ...... 117.7 119.3 90.2 101.4 68.6 89.3 107.6 117.7 112.7 73.5 1!35.4 

1MediMl care pfice index daflated by the 9eneral Priceindex. 

NOTE 19671 ndax= 100, 

Table 14, Relative price indexlfor medcalcare, by~peof sewices andgoods, withthe general price index France, 1950-78 

Medical Hospital care to Eyeglasses Total and General 

Yeer t%ysicians Dentists Assistants Laboratories Pharmacy and medical nursing ambulatory Medical price patients goods appliances care home index and home care2 care 

1 2 3 4 5 6 T A B c D 

Francs 

1960... . . . ..- . . . 89.11 94.12 67.70 131.79 57.57 

1955... .-. ..- . . . 101.71 95.00 93.34 129.06 75.01 

1860... 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 

1961 ... 91.59 93.43 100.21 96.82 98.37 100.11 99.53 102.30 93.63 98.76 103.28 

1962... 94.47 94.56 100.10 92.34 96.32 99.27 100.38 104.46 95.67 96.67 108.29 

1963... 97.51 96.54 97.33 108.61 91.61 98.21 102.53 111.10 98.48 92.48 113.53 

1984... 104.05 98.77 94.09 106.43 88.72 98.09 103.86 113.18 102.52 68.83 117.44 

1865... 105.47 100.48 93.58 103.89 86.68 99.73 103.84 112.63 103.80 88.10 120.32 

1966... 109.46 102,42 93.93 106.55 84.71 100.56 104.45 113.39 106.63 86.32 123.80 

1967... 111.55 104.06 94.45 111.62 82.56 99.41 104.61 113.89 108.63 64.21 126.84 

1968,,. 115.30 102.34 92.24 106.78 78.45 100.23 103.99 115.17 109.42 80.33 132.70 

1969.,, 120.38 104.87 94.82 71.94 76.69 97.08 106.22 121.04 112.52 78,46 141.22 

1970... 118.72 103.84 95.09 99.81 74.37 92.40 105.26 122.27 111.31 75.98 146.58 

1971,,, 119.97 104.46 84.51 100.38 70.26 93.10 104.78 125.03 112.12 72.11 156.71 

1972,.. 122.09 103,52 94.51 94.51 67.11 90.79 103.52 125.13 112.24 68.92 166.44 

1973.,. 125.01 107.39 95.36 88.03 62.17 85.56 102.52 127.49 114.21 63.91 178.70 

1974.,, 117,69 108.83 88.50 64.22 57.44 82.40 98.05 123.94 109.91 58.21 203.17 

1975.,. 120.53 106.52 88.15 79.60 54.58 78.68 102.95 129.62 109.78 58.34 227.00 

1976.., 121.69 104.75 86.83 84.67 50,63 74.29 99.08 135.45 108.97 52.57 248.68 

1977.., 119.04 108.39 86.83 71.77 47.93 72.03 97.85 134.71 108.17 48.70 272.25 

1978.., 119.63 112.46 86.50 69.19 48.58 72.83 98.75 135,63 108.99 60.33 297.01 

1Mediml care price indax deflated by the general Price index. 

2&cl”de~ nursing homes in France. 

NOTE 19641ndex=100. 

51 

1 
Table 15. Percapita medcalcare expenditures uncurrent value, by~pe of financing: France and United States, 1950-76 

1950 1%0 1970 1973 1974 7975 1976 

financing France United United United fiance United France United France United United 

‘rance states 

‘Ran=) (Dollars) ‘ta@s (;~n~) ~~~1~’) (Francs) ~Dollars) (Francs) ~~o&r~) (Francs) ~~~~r~) (i+ancs) ‘tites (Dollars) (Pa=) ~~o~~~) 

All sectors .............. 70,23 70.36 260.66 128.81 672.40 315.37 1,256.02 413.53 1,487.65 467.72 1,645.62 534.62 2,144.47 602.45 

Direct payments .... 27.67 46.12 102.86 70.66 224.21 127.36 316.52 157.27 366.84 165.43 438.31 173.65 471.53 190.91 

Philanthropy 

and other............. ,,. 2.07 . . . 2.92 . . . 4.77 . . . 5.63 . . . 6.55 . . . 6.71 .,, 7.26 

Mutual and private 

insurance ............ 1.40 6,41 9.38 27,18 30.53 75.54 43.86 100.56 53.56 116.70 64.60 142.11 79.92 168.02 

Total private ........... 28.07 !54.60 112.34 100.76 254.74 207.68 360.46 263.66 42%50 266.67 503.91 322.66 551.45 367,19 

Public funds ........... 9.80 15.78 23.20 2605 43.62 107.68 51.50 148.67 53.56 179.05 60.91 212.15 66.70 235.26 

Social Security ....... 31.26 . . . 125.12 . . . 574.04 . . . 644.05 . . . 1,011.60 . . . 1,281.00 . . . 1,525.32 . . . 

Total public ............ 41,16 15.78 146.32 28.05 617,66 107.68 685.54 148.87 1,065.16 179,05 1,341.91 212,15 1,583,02 235.26 

SOURCES: Csntra de Recherche pour L’&ude et L’Obsewation des Condition da Vie, Paris, and the Health Care Financing Administration, Baltimore. 

NOTE Figures may not add to totals due to rounding. 

Table 16. Average annual rate of increase of nominal value of per capita medical care expanditures, by services and goods 

France and United States, salected pariods during 1950-78 

firiod 

All medical care, 

services, and goods 

Medical services Hospital and 

nursing home care~ for ambulatory patients 

and home care 

Medical goods 

France United States France United States France United States France United States 

Average annual increase (percent) 

1950 -78 .......................... 14.1 8.8 15.1 10.4 13.9 8.1 12.8 6.6 

1950-60 .......................... 13.6 13.5 7.2 14.6 5.7 14.1 5.3 

1960 -70..,.,..., ................. 13.3 M 13.5 11.5 12.1 7.9 12.8 7.7 

1970-73 ....................,,,.. , 13.3 9.5 14.5 11.1 14.1 9.1 10.6 5,1 

1973 -78 .......................... 17.5 12.7 22.1 14.0 16.0 12.9 11.4 7.8 

1ficlude5 nursing homes in France. 

Table 17. Average annual rate of increaae of nominal price indexes’ for medical care, by services and goods 

France and United States, selected periods during 1950-78 

Period 

All medical care, 

services, and goods 

Medical services Hospital and 

nursing home care for ambulatory patients 

and home cara 

Medical goods 

France United States France United States France United States France United States 

Average annual increaae (percent) 

1950 -78 .......................... 6.4 4.7 7.4 5.5 7.9 4.8 2.5 1.9 

1950 -60 .......................... 6.9 3.4 6.3 4.4 9.9 3.0 2.8 

1960 -70.....................,,,.. 4.6 3.9 6.1 4.9 5.2 4.2 1,2 E 

1970 -73 .......................... 5.4 4.1 7.8 4.9 7.3 4.4 0.4 1.5 

1973 -78 .......................... 9.9 9.1 12.1 9.6 9.7 10.0 5.5 5.1 

1~cludw nursing homes in France. 

52 

1 
. . . . .

. . . . . . .

. . . . .

. . . . . .

. . . . . .

. . . . .

. . . . .

. . . .

. . . .

. . . . . .

Table 18, Average annual rate of incraase of per capita medical care expenditures in relative value and constant prices, by sarvices and goods 

France and United States. 1950-78 

Period 

All medical care, 

services, and goods 

Medical services Hospital and 

nursing home care~ for ambulatory patients 

and home care 

Medical goods 

France United States France United States France United States France Unitad States 

Average annual increase (percent) in relative value2 

1950 -78 .......................... 7.6 5.0 8.5 6.5 7.4 4.4 6.3 2.8 

1950-60.,,.......,,.......,.,.,.. 7.9
 4.1 7.4 5.0 8.4 3.6 7.9 3.2


1960-70.,,,....
.........,,.. 8.5 6.4 9.1 8.6 7.7 5.0 8.4 4.8


1970-73 ................... 6.6 4.7 7.6 6.2 7.3 4.3 4.0 0.5


1973 ................ 6.1 4.4 10.3 5.6 4.8 4.6 0.6 -0.2 

Average annual increase (percent) in constant prices3 

1950 -78.,.,,,,,., ................ 7.2 4.1 7.1 4.6 5.6 3.2 10.1 4.6 

1950-60.................... 6.2 2.7 6.7 2.7 4.3 2.6 11.0 3.4 

1960-70 .................... 8.3 5.2 6.9 6.3 6.6 3.6 11.5 7.1 

.

-78.,.,.


1970-73.,.................. 7.5 5.1 6.1 5.9 6.4 4.5 10.2 3.5


1973-78.,. ...... .... ....
.... 6.9 3.3 9.0 4.0 5.8 2.6 5.6 2.5


1Exclude$ nursing homes in France. 

2N~rninalvaluedeflated by the generalPriceindex. 

?.con~tantpricedeflated by the price index fOreachserviceCategow. 

Table 19. Average annual rate of increase of medical care prices relative to the general price index, by type of services and goods 

France and United States, selected periods during 1950-78 

R?riod 

All medical cara, 

services, and goods 

Medical services Hospital and 

nursing home care~ for ambulatory patiants 

and home care 

Madical goods 

France United States France United States France Unitad States Fiance United States 

Avarage annual increase (percant) 

1950 -78 .......................... 0.4 1.0 1.3 1.8 1.7 1.2 -3.4 -1.6 

1950-60,,.,,,,,., .,,,. !,,...
 ..0. 1.2 1.3 0.6 2.2 4.0 0.9 -2.7 -0.2


1960-70.,.,..,, ...... ....
.... 0.5 1.2 2.0 2.1 1.1 1.4 -2.7 -2.1


1970-73.,.., ..
..........,... -0.9 -0.5 1.4 0.2 0.9 -0.2 -5.6 -2.9


1973-78 .................... -0.7 1.1 1.2 1.5 -0.9 1.9 -4.7 -2.7


1Excludes
nursing homesin France. 

53 
Table 20. Nominal mice index and relative mice index of a hos~ital daw France and United States, 1950-78 

Nominal price index Relative price index 

Year 1950 = 700 1950 = 100 

France~ United States2 France~ United States2 

1950 ............................................................................................................... 100.0 100.0 100.0 100.0 

1955 ............................................................................................................... 163.4 148.0 125.4 133,1 

1960 ............................................................................................................... 300.0 206.3 172.7 167.8 

1961 ............................................................................................................... 325.7 223.9 181.6 180.2 

1962 ............................................................................................................... 367.6 235.8 195.4 187,7 

1963 ............................................................................................................... 397.8 248.1 201.7 195.9 

19w ............................................................................................................... 437.5 266.2 214.5 206,6 

1965 ............................................................................................................... 456.1 264.8 219.2 217.3 

1966 ............o....................o..............o........................................o..................... 461.6 308.3 224.3 228.7 

1967 ............................................................................................................... 519.5 346.2 235.6 249.7 

1968 ............................................................................................................... 581.5 393.0 256.6 272.0 

1969 ............................................................................................................... 709.9 446.3 268.4 284.5 

1970 ....o!.o....................................................................................................... 782.0 518.6 303.0 321.6 

1971 .....................................................................................#......................... 685.2 591.0 328.9 351.3 

1972 ............................................................................................................... 1,032.4 673.6 357.1 387.7 

1973 ............................................................................................................... 1,183.8 734.3 381.4 397,8 

1974 ............................................................................................................... 1,403.7 819.8 397.7 400.3 

1975 ............................................................................................................... 1,801.8 970.1 457.0 434,0 

1976 ............................................................................................................... 2,312.1 1,113.8 534.8 471.1 

1977 ..............................4................................................................................ 2,741.2 1,268.0 579.6 503.8 

1978 ............................................................................................................... 3,162.9 ..- 613.1 -.. 

1,nclude~ COWof stay and fees in all public and private hospitals. 

$?lnc[ud@~= of say in non.F~eral Shon.stay, general, and other institutiona (American Hospital *ciatid 

54 

I 
Appendix. Estimates of 

hospital expenditures in the 

United States and France 

by using a common set of 

definitions 

Definitions of hospital expenditures differ in the 

two countries studied. In the United States, hospital 

expenditures are expenses of hospitalized patients and 

the costs of outpatient visits but exclude payments for 

services provided in the hospital by private physicians. 

In France, hospital expenditures are only the expenses 

of hospitalized patients; they include the costs of the 

stay billed by the hospital and fees paid to the physicians for hospital care. 

Several factors help to estimate American hospital 

expenditures that correspond to those used for the 

French statistics. 

�	 In 1977, outpatient services were between 10 and 

15 percent of total hospital expenditures;1710 percent was used in this study. 

“	 In 1970, according to Andersen as quoted by 

Klarmann,2542 percent of all physicians’ services 

could be attributed to inpatient care. In this analysis, 40 percent was used. 

Unpublished HCFA data indicate that in 1978 the 

per capita expenditures for physicians were $158.08. 

NOTE: A list of references follows the text. 

These expenditures were $94 for 60 percent of ambulatory care and $63 for 40 percent of hospital care. 

Nursing home expenditures totalled $71. Hospital expenditures (including outpatient services but excluding 

physicians’ fees) were $341, from which outpatient 

care may be subtracted (10 percent of $341 or –$34) 

and to which physicians’ fees are added ($63). 

Therefore, for definitions comparable to those underlying the French statistics, per capita expenditures 

in the United States in 1978 were $128 for physicians’ 

services (ambulatory), $370 for hospitalization, and 

$441 for hospitals and nursing homes (institutional 

care). 

These estimates comprise the folIowing share of 

total personal medical expenses: 58.6 percent for institutional care, 49.2 percent for hospitalization, and 

17.0 percent for physicians’ services. 

Compared with per capita expenditures in France, 

those for institutional care are 14 percent higher and 

expenditures for physicians’ services are 39 percent 

higher. 

55 

* U. S. GOVERNMENT PRINTING OFFICE : 1983 381-161/112 
I 

Vital and Health Statistics series descriptions 

I 

I 

SERIES 1. 

SERIES 2. 

SERIES 3, 

SERIES4. 

SERIES 10. 

SERIES II. 

SERIES 12. 

SERIES 13. 

Programs and Collection Procedures. -Reports describing 

the general programs of the National Center for Health 

Statistics and its offices and divisions and the data collection methods used. They also include definitions and 

other material necessary forunderstanding the data. 

Data Evaluation and Mathods Reaaarch. -Studies of new 

statistical methodology including experimental tests of 

new survey methods, studies of vital statistics collection 

methods, new analytical techniques, objective evaluations 

of reliability of collected data, and contributions to statistical theory. 

Analytical and Epidemiological Studies. -Reports presenting analytical or interpretive studies based on vital 

and health statistics, carry ingtheanalysis further than the 

expository typasof reports in the other series. 

Documents and Committee Raports.– Final reports of 

major committees concerned with vital and health statistics and documents such as recommended model vital 

registration laws and revised birth and death certificates. 

Data from the National Health interview Suwey.–Statistics on illness, accidental injuries, disability, use of hospital, medical, dental, and other services, and other 

health-related topics, all based on data collected in the 

continuing national household interview survey. 

Date From the National Haalth Examination Survey and 

the National Health and Nutrition Examination Survey.– 

Data from direct examination, testing, and measurement 

of national samples of the civilian noninstitutional ized 

population provide the basis for (1) estimates of the 

medically defined prevalence of specific diseases in the 

United States and the distributions of the population with 

respect to physical, physiological, and psychological 

characteristics and (2) analysis of relationships among the 

various measurements withbut reference to an explicit 

finita universe of persons. 

Data From thelnatitutionalized Population Surveys. -Discontinued in 1975. Reports from thase surveys are included in Series 13. 

Data on Health Resources Utilization. –Statistics on the 

utilization of health manpower and facilities providing 

SERIES 14. 

SERIES 15. 

SERIES 20. 

SERIES 21. 

SERIES 22. 

SERIES 23. 

long-term care, ambulatory care, hospital care, and family 

planning services. 

Data on Health Resources: Manpower and Facilities.– 

Statistics on the numbers, geographic distribution, and 

characteristics of health resources including physicians, 

dentists, nurses, other health occupations, hospitals, 

nursing homes, and outpatient facilities. 

Data From Special Surveys. –Statistics on health and 

health-related topics collected in special surveys that are 

“ot a part of the continuing data systems of the National 

Center for Health Statistics. 

Data on Mortality.–Various statistics on mortality other 

than as included in regular annual or monthly reports. 

Special analyses by cause of death, age, and other damegraphic variables; geographic andtime series analyses; and 

statistics on characteristics of deaths not available from 

the vital records based ensample surveys of those records. 

Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other than as 

included in regular annual or monthly reports. Special 

analyses by demographic variables; geographic and time 

series analyses; studies of fertility; and statistics on 

characteristics of births not available from the vital 

records based on sample surveys of those records. 

Data From the National Mortality and Nataiity Suweys.-

Discontinued in 1975. Reports from these sample surveys 

based on vital records are included in Series 20 and 21, 

respectively. 

Data From the National Survey of Family Growth. -

Statistics on fertility, family formation and dissolution, 

family planning, and related maternal and infant health 

topics derived from a periodic survey of a nationwide 

probability sample of ever-married women 1544 years of 

age. 

For a list of titles of reports published in these series, write to: 

Scientific and Technical Information Branch 

National Center for Health Statistics 

Public Health Service 

Hyattsville, Md. 20782