Healthcare in France - An Introduction from FrenchEntrée.com

6th September 2010

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Healthcare in France - An Introduction

Despite being expensive to maintain - the deficit is currently round about 6 billion euros - and under constant funding pressure the French healthcare service is still one of the best in the world, offering a wide choice of general practitioners and healthcare specialists. For those who have experience of the health system in France and, for example, the UK, the contrast in standards can be startling.

The French healthcare system is funded by the working population. French employees pay about 20 per cent of their gross salary – the self-employed pay even more - deducted at source, to fund the social security system, known as Sécurité sociale. A significant proportion of this money goes towards public healthcare, to which every legal resident of France has access under the law of universal coverage called la Couverture maladie universelle.

*** In the past all EU expats arriving in France were eligible to join the French healthcare system. However, now those arriving in France after 23 November 2007, and who are not planning to work, are officially retired or in possession of documents which mean their healthcare costs are covered by the government of their original country, will not be allowed to join the system until they reach state retirement age or have lived here for five years. Until then, they have to hold private health insurance. For more on this see Healthcare changes in France - what you need to know.

When a person subscribes to Sécurité sociale, part of the cost of their medical treatment is covered by the state. However, regardless of cover anyone in France can consult a doctor or specialist. Similarly, everyone has the right to emergency hospital treatment, although for those who subscribe to Sécurité sociale, the cost is partly reimbursed.

State healthcare
To compare the NHS and private sector in the UK with the same in France is akin to comparing apples with oranges. There is no great difference in the quality of care between private and public hospitals in France and there is not necessarily any great difference in price. Being treated in private clinics in France does not mean avoiding waiting lists for the simple reason that, with a few specific exceptions, waiting lists such as those in the UK do not exist. And going private does not mean you will have to foot the entire bill.

Unlike in the UK in France treatment, whether private or public, is not free at the point of delivery. Even if you subscribe to the Sécurité sociale, on seeing a doctor or specialist (specialiste) you first pay the full bill (tarif) and are then reimbursed at a later date (about 10 days). Generally speaking, Sécurité sociale refunds 70 per cent of the cost of a visit to a médecin traitant (a GP or family doctor) and most specialistes. For more information on the level of reimbursement see Healthcare France FAQ

When you affiliate to the system you will receive your carte vitale (green card) which you must take with you whenever you visit a doctor, specialist or hospital, and when you pick up prescribed medicines.

The health system is currently undergoing the most substantial changes to the way it works since it began 60 years ago in 1947. This makes the situation ever changing, and increasingly complex.

Since 2006, to qualify for full reimbursement you must register with a médecin traitant – see How to Affiliate. If you attend a cabinet de groupe (group practice) you still have to nominate a particular doctor but should that person be unavailable and you need to be treated by another member of the practice, the rate of reimbursement will be the same.

Children under 16 years of age must have the declaration signed by a parent or guardian but members of the same family can have a different médicin traitant. If the GP or specialist is not your médecin traitant then the rate of reimbursement is only 60 per cent. There are exceptions to the reimbursement rule – for more information see below.

You are free to choose your own GP, and can change them at will by submitting a fresh declaration, which will cancel the present one.

The Tarif de Convention
In France all medical treatments from a routine visit to a GP to major surgical procedures have a tarif (cost). Medical practitioners and hospitals/clinics that adhere to this official tarif de convention are defined as conventioné. Those that do not are defined as non-conventioné and can charge what they like, although they do have to display their prices. If you go to a non-conventioné you will have to cover the extra cost yourself.

Perhaps, surprisingly, the vast majority of practitioners (around 97%) are conventioné, and even a private clinic can still be conventioné so ‘going private’ in France does not have the same connotation as that same phrase would in the UK.

Depassements.
However being treated at a conventioné does not guarantee the amount that you pay, and the reimbursement you receive. Although you may be treated by a medical practitioner classed as conventioné he or she can charge more than the Tarif de Convention provided it is "reasonable and tactful" to do so. So, for example, a surgeon who has extra qualifications or experience in other countries may charge extra for their services. This supplementary charge is called a depassement.

Depassements are not inevitable and are more likely to be applied in some parts of France more than others. For instance, they are commonly applied in Paris and the Cote d'Azur regions, perhaps because they are perceived to be more affluent. Although a few actes (procedures) by secteur 1 medical practitioners can attract depassements it is inevitable for those in secteur 2 (for the different between the two sectors see Specialistes below). A tarif or their charges should be displayed in their cabinets.

Top up Insurance or Polices Complémentaires/mutelles
Even when you are affiliated to the French system a fundamental principle of healthcare funding in France is the element of personal contribution. To make up the difference between what the state pays and the cost of treatment, most French residents take out an insurance policy to cover the difference (complement). This is called a police complémentaire or mutuelle.

Note: Complementary insurance is not private health insurance.

There are a wide variety of providers (including at least one UK insurer – seeHealthcare France FAQ offering an extensive range of plans to meet individual circumstances. The cover you choose is up to you - someone who is in general good health may only wish for cover for the really expensive items e.g. hospitalisation, leaving a routine visit to the doctor to be funded out of their own pocket. On the other hand someone on regular medication may require a plan that would cover this cost (prescribed medicines are reimbursed 35% or 65% by the state).

If your income after allowances falls below a certain threshold (for example, €10,768 for a couple) and you do not have a police complémentaire, you are eligible to complementary state-funded healthcare, the CMU complémentaire, which will make up the difference, although as a rule of thumb, it will only offer an average level of cover.

Your premiums will depend on age and level of cover required. An important principle with polices complémentaires is that the state must be proved to have paid its share before the insurance will pay the difference. Therefore, you must be affiliated before contemplating the purchase of a policy. See Complementary Health Insurance

Specialistes
Specialistes are divided into Secteur 1 and Secteur 2. Specialists of all types can be either 1 or 2 but the latter are more often encountered in some areas of France than others, for example, the big cities, particularly Paris.

Specialistes whose costs are covered by the state
Gynaecologists, ophthalmologists, and dentists are covered by the state without referral by a médecin traitant; young children can also visit any doctor without being referred by a médecin traitant.

Excess Payment for actes medicaux in excess of E91
The excess is 18€ but there are many exceptions such as laboratory tests and X-rays.

By FrenchEntrée Topic Host Peter Owen

NEXT:How to Affiliate to the Health System

SEE ALSO: Healthcare cover changes in France - what you need to know

For a more detailed look at the French health service, including a 15-page supplement on choosing complementary health insurance, see Healthcare in France - A Guide for the Expatriate, a 50-page guide, written by Peter Owen, a French healthcare expert of Expathealth Direct Ltd. The guide can help you plan your healthcare so it is cost effective, and considers key issues such as choosing the right arrival date into France and the link between E-forms and tax/financial considerations.

How to affiliate to the health system

Healthcare in France Home Page

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