Healthcare in France
The French healthcare system is reputed to be one of the best in the world, but you do need to know your way around it to make it work for you, says Kate McNally
The healthcare system in France has long been considered one of the best in the world, providing universal care at affordable rates for every legal resident.
The initial foundations of the current system were based on the UK model back in 1945 and remain fundamentally the same despite regular tweaks along the way. As in most countries, France’s health system is currently struggling with rising costs linked to increasingly expensive medicines, growing unemployment and an ageing population.
Like the country’s retirement pension scheme, the principles of the healthcare system are based on socialist ideals with everyone contributing to a collective pot. It is akin to the UK’s National Health Service in this way, with the majority of care paid from public funds. These funds are financed from mandatory health insurance contributions by employers (13%) and employees (usually 0.75%), paid monthly and indicated on wage slips together with other social security contributions. In France, however, operating on a parallel axis is the concept of personal contribution, with individuals expected to pay for a small percentage of diagnosis, treatment and medicines from their own pocket – either directly or through a complementary insurance scheme, known as a mutuelle.
A distinct difference from the UK healthcare system is that in France you pay for all treatment and medicines at the point of sale (or service) and are reimbursed at a later date, usually within two weeks. This is where the heavy administration comes in, with forms and letters sent backwards and forwards indicating what amounts will be, or have been, paid.
Red tape was simplified to a certain extent a few years ago with the introduction of the carte vitale, effectively a health smart card linking into the French social security system, which you hand over to the medical professional or pharmacist at every visit. Most procedures and medicines adhere to a fixed price model, set by the government health ministry. For example, a standard visit to your local GP costs €23. In general, from around 70% to 80% of costs are reimbursed from State funds. However in case of serious or chronic illnesses, such as cancer or prolonged mental health problems, costs are usually reimbursed 100%.
Should you miss work due to illness, you must get signed off by your doctor. You will lose your pay for the first three days off work, however from the fourth day your wages are guaranteed, either in full or a large proportion. Payments are received either directly from the State assurance maladie fund, or via your employer who is reimbursed by the assurance maladie. No payments will be made without an arr�t maladie certificate from your doctor.
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Similarly, should you have an accident at work, your wages are normally maintained until you return. If you have an accident unrelated to your work, however, it is considered your responsibility and you won’t be paid for time away from work. For this reason, many people take out a personal accident (and life) insurance policy as in the UK.
There are three principal State insurance funds, the largest of which is l’Assurance Maladie des Salari�s (AMELI), a R�gime G�n�ral which is administered by a network of local offices across the country known as CPAM (Caisse Primaire d’Assurance Maladie). The majority of employed, unemployed and retired people are covered by this fund and in all around 85% of the population living in France is affiliated to this general health fund.
Business owners and self-employed workers come under a different scheme, the R�gime Social des Ind�pendants (RSI), while the agricultural sector is covered by the Mutualit� Sociale Agricole (MSA).
As healthcare in France is not 100% free, most people take out additional personal health insurance to help pay the remaining costs. There are numerous insurers to choose from and, as with all types of insurance, a wide range of policies with varying degrees of cover and premiums. It is worth shopping around and seeking advice to ensure you choose the best policy for your needs and budget.
However this complementary health insurance should not be confused with private health cover in the UK. Although bought by the individual, it simply assists financing the personal contribution element of French healthcare. It is inexpensive, does not guarantee faster treatment times and is not affiliated to private practitioners or clinics as with the UK private healthcare model.
In terms of payment, the individual pays for treatment and the relevant State fund is automatically alerted via the carte vitale system. The percentage refunded by the State is then indicated to the relevant mutuelle which calculates accordingly how much it will reimburse.
With time delays and complex paperwork, it can take a certain amount of effort to follow the trail and ensure you have been repaid what is due!
The majority of doctors and specialists, such as osteopaths, dentists and physiotherapists, are independent, working for themselves or in association with other private practitioners, however they are paid from the public health funds.
The French Ministry of Health fixes the price of services in consultation with medical experts and negotiates a set price for medicines, treatments and health-related equipment (for example prostheses or crutches), with the pharmaceutical companies and relevant medical suppliers. These fixed rates are known as the tarifs de convention and ensure uniform costs across the country, so in normal circumstances people simply go to their local doctor or nearest specialist. It is important to note that payment from the public funds for most treatment, such as a course of physiotherapy, is only guaranteed if the individual is referred initially by their GP. Similarly, free or cheaper medicines – even for more regular items such as Ibuprofen – are only available through a doctor’s prescription. If you go direct, it will almost always be more expensive. There exist some notable exceptions, however. For example, you can go direct to a gynaecologist or dentist of your choice, as they are covered by the State without requiring a referral.
Occasionally some treatments, or the reputation and experience of certain specialists, allows a surplus charge – known as a d�passement – which an individual will need to pay him- or herself if their mutuelle doesn’t cover it.
There is a small percentage of private practitioners (in the UK sense) who operate outside the public health system and who can set their own rates. These are known as non-conventionn�s operators because they do not adhere to the tarif de convention. However, they must indicate their Secteur 2 status (as opposed to Secteur 1 who comply with regulated prices) and clearly indicate their price structure.
In France, the majority of hospitals are linked to the public health system. Emergency treatment is available to all and hospital procedures are reimbursed in the same way as standard healthcare.
Non-medical costs of a stay in hospital, that is food and board, are charged on a daily rate but are not unduly expensive.
When you move to France, it is worth obtaining an S1 form from the Department for Work and Pensions which you can take to the nearest CPAM bureau on your arrival. This will entitle you to access to the French healthcare system for a defined period of time, assuming your NI contributions in the UK have been sufficient.
Without the form, you will not be covered for the time it takes to obtain a social security number and be registered as living in France. If for any reason you are not eligible under the European Economic Area healthcare exchange arrangements, you will need to take out a form of private health insurance.
Once you start working in France, you automatically enter the system and will be required to pay contributions, deducted at source from your salary.
If you are retired and moving to France, check your status for healthcare entitlement, as it can be variable.
Under rules introduced in 2007, you may not be eligible before reaching official retirement age or until you have lived for five years in France. LF