Cream Barley and Chard Gratin; French v US doc visit – one comparison

I have not been following the US Health Care debate. 

I actually don't know if there still is a debate or if the dust has settled.

I do know that I often get questioned about the French Health care system.

After my visit to the doc yesterday I decided I could give one pretty equal comparison.  I'm going to try to make it as unbiased as I can.

In the immortal words of Joe Friday: …just the facts, ma'am.

Both doctors were Dermatologists.  In both cases I went for an annual skin check.

I'm more descriptive of the French visit only because, unlike the US visit, it will be unfamiliar to most readers.

US visit:

The offices were nice, not overly so, but carpet on the floor, upholstered chairs in the waiting room, magazines on tables, pictures on the walls, quiet music piped in.

There was a large desk with several staff taking information, checking insurance, updating records, etc. I filled out a 3 page form and gave it to them.

I don't know how many doctors worked there, but I assume quite a few.

I was shown into an exam room by a nurse, given a paper robe, paper sheet and told to undress.

The doc came in, dressed in white doc clothes, with a laptop and asked a few questions. 

She did the exam, carefully not exposing too much of me at any time, and removed 3 moles that she said looked pre-cancerous.

She told me to get dressed and left the room.

The nurse came back and told me I could leave.

I went to the desk and paid $355.00 for the visit.

I have no US insurance so it was my expense. I have no idea what it would cost a typical person with typical insurance.

French visit:

The waiting room had bare bulbs on the ceiling, linoleum on the floor, bare walls and plastic chairs.

There was no desk and no staff.  It's your turn when everyone else currently waiting has been seen. After the doc walks the current patient to the door, he nods to the next one in line. There's a buzzer on the door that one pushes on the way in to announce one's arrival.

In the office proper there is an exam table and what appeared to be state-of-the-art equipment on one side of the room; a desk with a large screen computer and visitor chairs on the other.

The doc, dressed in a casual shirt and slacks, took my name and address, typed it into the system and verified my Carte Vitale (medical card).  I'm guessing, although I don't know for sure, that he accessed my records on a national database.

After a brief chat he told me to undress – and walked with me to show me where to put my clothes.  He gave me a hand on to the exam table.  No robe; no sheet; no nurse.  Actually, there was no one else anywhere.  I was the last person in the waiting room. 

He did the exam and removed 2 moles that he said were not a problem but not pretty (he asked first).

He told me to get dressed and went back to his desk to update the records.  He hand wrote the bill, and I paid cash, about $50.00 for the visit.  I'll send the bill to the local CPAM offices and they'll reimburse me in full.

He walked me to the door, shook my hand and I left.

These were 2 very different experiences and 2 very different costs.

No opinion is being rendered…. I just thought it was interesting.

Here's something else that was interesting…

And I want you to know I had to search hard to find something that had neither zucchin or tomatoes in!

Barley and Chard Gratin

Creamy Barley and Chard Gratin

1/2 cup quick-cooking barley
1 cup chicken stock
8oz (240gr) chard, stems and leaves
1 medium onion
1 tbs fresh parsley
1 tbs fresh basil
1/2 cup (2oz, 60gr) shredded cheese
2 tsp oil
2 eggs
1/4 cup Greek or plain yogurt
1/4 cup milk or chicken stock

Cook barley in chicken stock until done, usually about 15 minutes for quick-cooking.
Chop onion. Wash the chard and trim any bad bits. Stack the leaves together and fold over, the long way. Slice into thin strips, using both leaves and stems. Snip herbs.
Heat oil in a large skillet. Add onion and chard stems to skillet and sauté until tender, about 7 minutes. Add the chard leaves and sauté until wilted. Remove from heat. Stir in herbs.
Whisk eggs, yogurt and milk together.
To finish: Spread chard / onion mixture in the bottom of a baking dish just large enough to hold everything. Add barley, spreading evenly over vegetables. Sprinkle with cheese. Pour egg mixture over the top and bake, uncovered, for 30 minutes, 400F (200C), until nicely browned and set. Remove and serve.

Creamy Chard and Barley Gratin

In case you're wondering why I went to the US doc last year… I had been seeing the same doc for years, although it had been 4 or 5 since the last visit.  He always charged me around 55.00 for a visit.  When I called for an appointment I was told he'd retired…. I made the appointment with his successor.

11 thoughts on “Cream Barley and Chard Gratin; French v US doc visit – one comparison”

  1. Wow. That IS a revelation. To give the Canadian perspective, please excuse my verbosity. Last summer I made an appointment to see my dermatologist because I didn’t like the look of a mole. About 10 minutes before my appointment, I signed in with the receptionist by giving her my name and health card number. Then I waited in a nicely decorated anteroom with couches, comfy chairs, magazines, soft lighting and several other patients. I can’t remember but I believe there are 4 doctors working in that particular office. About 20 minutes after my appointment time, the receptionist called my name. I was ushered into the doctor’s exam room. After another 20 minutes or so, the doctor came in and asked to see the mole in question. She looked at it, said she didn’t think there was anything to be concerned about but why not check elsewhere. She then told me to undress, to drape my clothes on the chair and then sit on the exam table. She checked for suspect moles, identified one she didn’t like and asked if I wanted her to remove it then or to make an appointment. I chose then. She removed the mole, stitched up the hole, put a bandage on it, told me to get dressed and to call the following week to ask for the results which she suspected would be negative but that it was good to check anyway. We said goodbye. My payment? $0.
    I’m starving. May I have two portions of that gratin please? And if it’s not too hoggy, might I have a third portion for dessert?

  2. How about a Northern California perspective. My Beloved and I have Kaiser. He had a mole on his face that was changing and we were worried. He made an appointment with his primary physician, checked in about 10 minutes early and made his $20 co-pay, sat down in the very pleasant office with magazines, etc., was called on time for his appointment. The doc had all his records on a very sophisticated computer system (all the medical professionals we see can access our records from any Kaiser facility). The doc looked at the mole and said it was unsightly but of a type that never becomes cancerous and asked if MB wanted it removed. He did, so the doc left and returned with a canister of liquid nitrogen, zapped the mole, patted MB on the shoulder and left. No need to undress. Now that sounds wonderful, doesn’t it, but there’s also the roughly $200/month that we pay for him to belong to Kaiser’s Medicare coverage, so it’s not as cheap as it sounds. But, at least we don’t have to obtain reimbursement from the insurance company! 🙂

  3. This is so interesting reading everyone’s take on it. I find it particularly interesting how in France the doctors do so much themselves.

  4. I can’t resist (the gratin, of course, but also my stories). In England, I opted to pay for private insurance. Went to the dentist for an annual exam. The waiting area was the hallway in from the street, with mis-matched chairs. I checked in and when it was learnt that I was a “privately insured” patient, I was ushered upstairs (away from the NHS mob) to a carpeted waiting room in some disrepair. I was taken in to see the dentist in a plain office (the dentist was quite competent). I noticed a door. That door was for the yobs in the downstairs waiting room– er, hallway. So it was the same dentist, same quality of care. The only difference for my private insurance was a dubious “private” waiting room. The cost for an exam and cleaning was completely reimbursed by my insurer to the tune of about USD 28.
    In Belgium, as in your story, the dentist was a staff of one. He was German and said that the “business climate” in Belgium was better. He said that it was too expensive to hire a dental tech or front office staff. He had the best equipment, the likes of which I haven’t ever seen in the US (such as a digital X-ray machine hooked up to a laptop, where X-rays were taken in the chair vice going to another room and that lead smock). The cost was USD 12 for an exam and cleaning. (Shockingly, the cost of my annual physical exam was USD 32. Outrageous.)
    In both countries, it might be noted, the tax rate that supports such low fees is shockingly high. In England, my landlord retired early from teaching because he said he brought home more money on a pension than as a working stiff. Sounded awful, until I saw his two BMWs. I never figured out England and salaries and taxes, esp after seeing that.

  5. The dust hasn’t really settled, and we have mid-term elections in November. The mudslinging has started, even in “polite” Minnesota, and I’m already thoroughly sick of it. I do NOT need to be awakened by snarky political commercials on the radio in the early AM. 😛 I’m not going to comment further as this is not a political blog, but let’s just say that politics in the US has gotten really, really polarized and few people understand distinctions in any system other than “democracy/capitalism”.
    My DH and I have it really pretty good — he works at the University of MN, which still has pretty darn good benefits for staff, and we are both (relatively) young and healthy, although we both have certain “first world” health issues starting to creep up that we are watching and trying to rectify before they become *actual* health issues (cholesterol and blood pressure stuff). My co-pay for most office visits is $10 for medical, and I believe my bi-annual dental exam/cleaning is completely covered, although we pay some for dental work. Comfortable, mostly competent care, but I’m really glad we are young and healthy! And insured. The health care system for the uninsured here in the US can be a nightmare.

  6. I sat in an allergist’s office here in Provence and he took a phone call and told the patient he or she had stage 4 lung cancer and TB. I don’t think they would do this in the States. I’ve never been to a doctor with a nurse to help, even in the GYN office and decoration is never high on the list for offices. Air conditioning is rare too. But it’s hard to complain when it comes time to pay.

  7. Here in Australia a private dermatolgist will leave you out of pocket after Medicare. The doctors will have extravagant rooms and be double booked and the bill will be hefty as will the wait. Our GPs can remove any mole that is raised but anything flat must be seen by a dermatolgist. I work for 6 GP’s, the rooms are basic and we are rushed off our feet with patients who often are waiting ages but the vast majority do not pay so they are lucky – that includes me being an employee !!

  8. UGH don’t even get me started on US health care. That’s a debate that will never end.
    This gratin though. Delicious!

  9. I work for a doctor here in Canada. The only difference in the visist is that there would be no bill in the end. I can see where the bill would be less in France when there are no staff to pay for and no frills. But back to the recipe..it look delish:D

  10. Elizabeth – my payment will be ‘0’ but the private docs aren’t set up to handle the the Carte Vitale for payment – don’t know why, but none do. Another cost saving, I suppose. You may have 3!
    Zoomie, getting the reimbursment is easy and 100% – the doc gave me the signed form, I drop it in the mail or at the local office and they wire the money into my checking account. I’ve hard good things about Kaiser.
    Pam, I think it is, too. I’ve been to one dental office where they had several dentists and a receptionist, but it’s not common.
    TikiPundit, my dentist here has that same equipment – it’s wonderful, isn’t it? Love the story about the waiting rooms…. Ah yes the taxes…. It all does have to be paid for….
    Laurie, I’m going to be in ‘polite’ Mpls in Oct…. so I’ll get exposed to all the fun! If you are a legal resident here you are insured. My son, in Mpls, is not (because of an illness he was cancelled)
    Linda, ouch, that is harsh… but the person on the other end probably didn’t know there was a witness. I have a hard time with the total lack of ‘bed-side’ manner – but I’m getting used to it. My hubs has gotten excellent care in hospital over the last year and, like you say, it’s hard to complain.
    manningroad, it sounds like the Australia system is much closer to the US system with some docs making really big money!
    Joanne, it shouldn’t be that hard – but I understand that it is (and why – I worked in the medical insurance indusdtry in US before moving here)
    Val, we patients do have to do more work here – like mailing in the form. We also have to be responsible for our own paper files, x-rays and such. Gratin is Good!

  11. a nurse, piped in music and carpeting sure is not worth $300.00. I have been to doctors and ERs and such in other countries and I found better service and medical care for a fraction of the price there. It is CRAZY here (here (here being the USA)

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