Professor Alice Teil lives in France, a country with one of the most democratic health care systems in the world. (Just ask "Sicko" filmmaker Michael Moore.) But America can also teach the French something about good medical care, Teil says.

Teil, a researcher at University Jean Moulin in Lyon, France, has been in Salt Lake City for the past week observing Intermountain Health Care. IHC became a sort of mecca for Teil after one of her doctoral students did a survey of 10 international health care experts and found that IHC ranked No. 1 when the question was "name the three best hospitals in the world."

What IHC does so well, Teil says, is deliver good quality care and have the measurements to prove it.

What France's health care system does especially well is provide good care with equal access to all, regardless of income, age and "existing conditions." It was a democratic ideal that worked well when there was enough money to pay for it, says Teil, but it has become problematic as costs have risen, baby boomers have aged and the economy has stalled.

Maybe it's time to rethink the extent of France's notion of egalite when it comes to, for example, providing 100 percent of the costs for knee replacements and other "comfort services," she says. "We need to raise those issues to the population, because it's not sustainable anymore."

A chart compiled by Teil, who has studied health care systems for the French government, shows that France pays for alternative medical practices, in vitro fertilization and sex change operations (although, oddly enough, not eyeglasses).

Attempts to ration health care in France have so far not worked, she says. When the government tried to limit people to three primary care doctor visits a year, for example, physicians complained. When the government took 200 drugs out of coverage, the pharmaceutical industry fought back.

On the other hand, funding reform in France in recent years has meant that public hospitals are no longer bailed out by the government if they go over their budgets for patient care. It's been a shock for the hospitals, Teil says, and it's requiring them to change their strategies.

France's health expenditures represent a smaller percentage of their gross domestic product, compared to the United States. France spends 10.4 percent of its GDP on health care; America spends 15 percent. Spain spends 7.9 percent — but has an average life expectancy of over 80 years, compared to less than 78 for the United States.

But, as with everything else when it comes to health care and health care policy, the reasons are more complicated than comparing dollars spent or years lived.

IHC, she says, has a "strong will" to use medical practices that have been proven to work best. France could also learn a thing or two about measuring what works and providing that information to the public. "We see measures as a way for government to control us more," she says. And in a system where outcomes are not measured, "there is no incentive to be the best, because nobody will know you're the best besides you."

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