Posts Tagged ‘Healthcare’

Questions with Bupa International about expat issues, moving abroad

January 10th, 2014 No comments


I will be enhancing my content this year to provide more insight about expat issues.

Bupa International is known for working with international expatriates, employers and families.

They were recently able to answer some of my questions below that are relevant to expat issues. Please see those questions and answers below (note British spelling at some points).

They also recently interviewed me on expat issues, and that article will be posted later.

In addition, I’d recommend checking out their free guide to moving to France, available on this page.

What issues have you seen develop for expat clients moving abroad for the first time? What kinds of information do expats seek?
Moving abroad for the first time can be both exciting and daunting, and the issues facing expats often depend on individual circumstances. Those who are taking their family with them, for instance, may have the added responsibility of finding suitable schools for their children, and so issues can sometimes relate to the standard of education and any potential language barriers they may face.

A recent study from the Daily Telegraph identified the most common issues people moving abroad requested information about. Unsurprisingly, issues such as tax, domicile and residence featured high on the list, as well as information regarding employment, visas and work permits. International health care and insurance is another important aspect of moving abroad, and one which it is crucial to read up on in order to find the best arrangement for you and your family. Many people also enquire about international money transfers and currency exchange, whilst information on the transfer of UK pensions and overseas pensions is also frequently requested.

How easy is it for expats to get coverage for their families while living abroad?
We understand that modern day life can often bring about quick changes, such as moving abroad due to work commitments. Whilst an individual may have personal health cover, it is crucial to ensure the entire family are protected by a suitable health policy. Because of this, we have made it easy to tailor your health cover during your policy, meaning additional family members can be included as and when required.

Does Bupa prefer to work directly with both international and local employers rather than freelance consultants?
We strive to work with local employers wherever possible, but depending on location it may sometimes be impossible to rely solely on local or international employers. Varying legislations around the world mean that some Partners or Brokers may be required in order to give us the coverage needed. Our focus is always on providing the best possible service.


French venture capital at record levels

According to the the March 22 edition of French financial daily La Tribune, venture capital in France in 2010 reached its highest levels since 2000. For those of you who cannot read the article (due to subscription restrictions), I have summed it up in English below.

An interesting linguistic note that reveals a lot about cultural differences is the expression in French for “venture capital”: capital-risque, or “risk capital”. So whereas the risk-taking “Anglo-Saxon” cultures positively think of investing in businesses as “ventures”, the actual French term emphasizes the traditional risk-averse culture of France (that is gradually evolving, as the article illustrates).

Another example of this difference is that more Americans and British invest in stocks for their pensions whereas it is less of a natural option for French workers. But this too is changing.

I have some venture capital links on my business in France page.

Do you have any views of venture capital and investments in France?

“Le capital-risque en France retrouve des niveaux record”

Venture capital funds invested about €1.05 billion in 2010 (compared to €910 million in 2009). This is the highest amount since 2000, when VC reached €1.14 billion.

Investment over the past six semesters (notice the dip 2nd half of 2009)

2008: €470 mil (1st semester), €556 mil (2nd semester)
2009: €503 mil (1st semester), €407 mil (2nd semester)
2010: €515 mil (1st semester), €532 mil (2nd semester)

Most capital came from local investment funds, or FIP (Fonds d’investissement de proximité) and innovation mutual funds, or FCPI (Fonds commun de placement dans l’innovation). In fact, the second half of 2010, FIP’s and FCPI’s represented 62.5% of investments.

N.B. you can learn more about these and other French investment terminology here. See below for explanation of FCPI from that link.

Another trend is that most venture capital firms invest in the last stage, or second rounds, instead of early stage investments. Early stage made up only 7% of VC investments in the last ten months of 2010.

One last note is that the health, life sciences and pharmaceutical industries make up almost 25% of venture capital investments.

FCPI: French type of mutual funds, created in 1997, intended to support the development of innovating firms.

The capital collected by a FCPI is invested at least up to 60 % in the capital of non listed companies, or of limited liability companies, to which the Agence nationale de la valorisation de la recherche (ANVAR) gives the label “innovating”.

Subject to keep the FCPI shares during at least five years, the subscriber profits from tax advantages at the time of the subscription (tax cut) and at the time of the resale (possible exemption of the cashed products and the appreciations in certain cases)

Expat Expo in Paris Feb 4-6

January 28th, 2011 No comments

This below from the Expat Expo website (English version. There are also 8 other languages, quite impressive). You have to register (and pay) to attend. How to get there. Enjoy!

The first edition of the event Expat Expo will be held on the 4th, 5th and 6th of February 2011 at the Parc Floral in Paris. Expat Expo caters for all expatriates in France whether they are executives or managers, pensioners, students, property owners or investors, but also those who are preparing for a future expatriation.

For executives and managers dealing with international mobility, EXPAT EXPO is an opportunity to meet and network with industry experts to improve your knowledge on key topics such as legal issues, tax and social expatriation… Relocation agencies, banks, insurance companies, schools, tax consultants, recruitment companies, estate agencies… are waiting at EXPAT EXPO to offer you advice, information and services to aid your expatriation experience.

For existing expatriates, the fair is an opportunity to explore new opportunities and plan new projects. Travel, sport, culture, social life, investment, education, shopping… Visitors to the show will find everything they need to fully enjoy their new life.

New poll finds the French “world champs” of pessimism

January 19th, 2011 3 comments

I enjoy living in France, but it is true that even the French make fun of their complaining as the national pastime. This article comes from Expatica (Anne – Laure Mondesert / AFP / Expatica) and speaks in depth about the poll. Excerpts below. I do have friends who are optimistic, driven and talented, but in my experience here, there is definitely a collective malaise. Cheer up, you have it very good compared to many others!

French are world champs in pessimism
A poll completed early this month shows the French even more pessimistic than violent-ridden countries around the globe, but what’s their reasoning?

Paris –The French live in one of the richest and safest countries in the world, yet they are global champions of pessimism, fearful of the future and longing for the past, according to a survey published early January.

“The French are afraid. They feel the present is less good than the past and that the future will be worse than the present, and that their children’s lives will be harder than their own,” said commentator Dominique Moisi.

“There is a morosity, a real phenomenon of clinical depression,” said Moisi, the author of the 2009 book “Geopolitics of Emotion: How Cultures of Fear, Humiliation, and Hope are Reshaping the World.” Moisi was sceptical about the BVA-Gallup poll published that suggested that the French were more pessimistic than people in Afghanistan or Iraqi who daily face high levels of violence.

But he conceded that it had some substance. He and other commentators said several factors were to blame. France’s comparatively generous welfare state is no longer perceived as sufficiently protective in the face of the ongoing economic crisis here, they said.

“The French behave towards the state like teenagers with their parents. On the one hand they rebel, but on the other they want ever more protection,” said Moisi. French pessimism is nothing new. The French are Europe’s biggest consumer of anti-depressants. But their gloomy tendencies have been made worse by rising unemployment and a tense social context that in recent months has seen millions take to the streets to protest raising the retirement age from 60 to 62…

He said that it was above all the middle classes who were being affected by pessimism. They see their jobs as becoming less and less secure and fear their quality of life will be reduced. “The French are sensualists, epicureans… and we are seeing a discrepancy between the little individual joys and the collective malaise,” said Delevoye….

…The BVA-Gallup poll described the French as the “world champions of pessimism.” It found that 61 percent of French thought that 2011 would bring economic difficulties, compared to an average of 28 percent in the 53 countries surveyed. Sixty-seven percent believed unemployment would rise again this year, a more pessimistic view than than in every country except Britian — 74 percent — and Pakistan — 72 per cent. Thirty-seven percent of French people polled said this year would be worse than 2010, making them considerably less optimistic than Afghans — 14 percent or Iraqis — 12 percent. Anne – Laure Mondesert / AFP / Expatica

What the Health Care Overhaul Means for Americans Abroad

With the recent passing of the new health care bill in the US, I thought posting this piece from the New York Times was timely:

March 23, 2010, 11:19 AM
What the Health Care Overhaul Means for Americans Abroad
On Monday, Times reporters answered reader questions about how the health care overhaul will affect consumers. But one reader question that remained unanswered was how the legislation will affect Americans abroad. Here’s the answer.

According to Tom Rose, chairman of the Association of Americans Resident Overseas‘ Committee on Social Security and Medicare, the legislation doesn’t have any effect on Americans abroad, except that it exempts them from the penalty for not subscribing to health insurance in the United States. “That is only logical as most Americans abroad have coverage in their country of residence,” Mr. Rose said.

Similarly, the Web site of the American Citizens Abroad organization pointed out that, as of January, neither the House nor Senate bill would tax Americans abroad for not having insurance in the United States, and both “specifically exclude overseas Americans from proposed mandatory U.S. health insurance coverage.”

According to the organization, an earlier version of the Senate health plan would have taxed Americans abroad.

But the group noted on its site that provisions for financing the legislation were “likely to affect Americans overseas, whether they be additional taxes on high incomes or increased deductions for Medicare and Social Security (which would affect American-owned businesses abroad).”

How do you think the legislation will affect Americans living abroad? If you’re an expat, how do you think the legislation may affect you?

Yes “Oui” Can? Informing the Healthcare Debate: The French Example

November 12th, 2009 2 comments

An original piece originally published in September on Scoop44 (now ScoopDaily):

By Michael Barrett / September 7th, 2009

As the healthcare debate remains intense in Washington and across the country, leaving fiery protests at town hall meetings in its wake, one way to have a more knowledgeable discussion is by looking to examples of healthcare in other countries.

The Obama administration has been criticized by some conservatives as wanting to impose a socialist system in not just healthcare but also in economic matters. One of the countries referred to the most by both critics and proponents of Obama’s policies is France, the supposed beacon of socialism and the welfare state. It is important, however, to get beyond ideologies and examine the facts. What could the U.S. learn from the French healthcare system, both what to do and what not to do?

France’s public health system provides a basic form of mandatory health coverage for everyone, including foreign residents like myself with valid working papers. The main fund, Sécurité Sociale (Sécu), covers 80 percent of the population, and two other entities exist for the self-employed and agricultural workers. France also provides options for those ineligible for Sécu or below a certain salary threshold.

Everyone covered by the system uses a health insurance card resembling a debit card, called a Carte Vitale. This is equipped with a computer chip that can be read by doctors’ and pharmacists’ computers to access a patient’s insurance coverage information. All French citizens from 16 years old are required to have one; those younger are on their parents’ plans. While practical, this card can represent the excessive paperwork and hurdles that foreign residents must get through in order to obtain one. It took me several months to get my Carte Vitale, somewhat delayed because I had provided one too many pieces of identity for their comfort.

This notorious bureaucracy makes even the French cringe, but there is a silver lining: when getting laid off from a job does not result in losing a steady health insurance plan, the benefits seem worth the hassle. These are reaped not only individually but also economically. Indeed, the French social safety net played a role in bringing France officially out of the recession this past quarter, providing a stable foundation for increased consumption and other economic activity.

In addition to the public system, there exists a huge private market for health insurance in the form of supplementary medical plans known as mutuelles. These tend to pay for some of the costs not covered well by Sécu. Most French opt for these; the Boston Globe puts the rate at 90 percent of the population. For non-E.U. citizens moving to France, private medical insurance is mandatory.

These mutuelles are run by private insurers that offer a variety of plans to different groups, from students to professionals (and this is again subdivided into job sectors, like teachers). They often cover expenses not already paid for by the Sécu. For example, the standard doctor’s consultation will cost 22€ (about $31) and Sécu will normally reimburse 70% of this, or 15.40€. The mutuelle will usually make up some or all of the difference. My mutuelle is with the LMDE (la mutuelle des étudiants – student’s private option), which along with the other student option (SMERRA),offer beneficial plans to students in coverage and cost.

I just upgraded mine, and it will help cover most prescription costs, doctor visits, some dental and eye appointments as well as hospital stays. The cost for my total coverage per year? 393€ (195€ for Sécu, 198€ for LMDE) – about $560 a year ($47 a month). Not bad, considering that this covers the entirety of my asthma prescription costs for medicines I take daily, for which I’d pay a lot in the U.S. even with insurance. Not to mention a good portion of the costs incurred for hospital visits, dentist appointments and other procedures.

This is one of the key differences between the French and American systems. In the U.S., if you are prone to illness or have a chronic condition, health insurance providers will often either increase your payments or drop your coverage. As stated in the Boston Globe article, the French system makes it “more difficult for insurers to deny coverage for preexisting conditions or to those who are not in good health.”

Another difference is that associated with unemployment. If you lose your job in the U.S. and are not covered by government employee plans, you will likely have to pay more for private health insurance than through a company-provided scheme. In France, everyone is covered by the public option so that even those laid off by their employers don’t have to fear enormous costs in going to the doctor in case of illness.

One more aspect is that when ambulances are dispatched to treat injuries, a doctor comes along with appropriate equipment to start treating the patient at the scene before going to the hospital for further care. This was featured by CBS news.

The benefits can be seen in many ways, such as life expectancy: France is ranked 7th among UN nations (77 years for men, 84 for women), whereas the U.S. is at 35th (75 for men, 80 for women). Moreover, the World Heath Organization (WHO) has ranked France’s healthcare system as the best (though debatable). Indeed, according to the Boston Globe article, France’s ranking is based on “its universal coverage, responsive healthcare providers, patient and provider freedoms, and the health and the longevity of the country’s population.” The U.S. comes in at a meager 37th place. People like Fox News anchor Glen Beck should reconsider their statements.

Image: The Economist

So we see that the system in France has positive aspects, but what could be the costs of such a universal scheme? It does not come cheap, at about $3500 per capita (Boston Globe), but it is much less expensive than the U.S. ($6100). In terms of overall spending, France devotes 10.5% of its GDP to healthcare, whereas America spends 16%. More on the U.S compared to other countries of the Organization for Economic Cooperation and Development (OECD) can be found in this 2004 report. As addressed by Medical News Today, the financing for the public health system is provided for by employers, employee contributions and personal income taxes, with around 20 percent of a working person’s gross salary deducted to pay for the Sécu.

There should be no surprise, therefore, that French authorities are trying to cut down on costs in the system. According to this article, instead of years ago when people would go to any doctor they wanted, “family doctors must now coordinate treatment.” I have witnessed this in France, where a patient must have the approval of his or her general practitioner before going to a specialist for a specific problem (exceptions: gynecologists, ophthalmologists and dentists – no need for referral).

There certainly needs to be reform in the U.S. of some sort. Indeed, the majority of Americans view the U.S. health system as “average” or “below average” according to the Pew Research Center. Even if a public option comes into existence in the U.S., it would likely not be mandatory for everyone, unlike the French system. The crux of the debate is whether or not a government-run public option would result in healthy competition with private insurers and lower premiums or if it would dominate the market and be a weight on business. A public health insurance option in the U.S. might dramatically increase coverage, but it will be vital in the long-term to reduce cost. Streamlining government bureaucracy could contribute to that endeavor.

Policymakers in Washington would be wise to take heed from French lessons of mixing public with private insurers. According to the American Journal of Public Health, these lessons include: “the importance of government’s role in providing a statutory framework for universal health insurance” and “understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market.”

We can learn from France without becoming France, taking what works and leaving aside any nuisance to long-term growth while encouraging innovation to reduce costs, increase coverage and improve medicines. Our collective health depends on it.

If you would like a very in-depth analysis of the benefits and pitfalls of France’s whole economic system, I invite you to read the Economist article cited here. You can find more info on the French social protection system here and on this site.

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