The costs of using the French health system

Ron Wright throws the spotlight on the financial implications for expats receiving care under the French health system

The French state healthcare system is quite different from the NHS in the UK. First and foremost, it is a reimbursement of medical expenses system. But the state only partially reimburses your medical expenses and this is why it is called basic French state health cover. Prudently, the majority of state-insured persons in France opt to purchase complementary health insurance to top up some or much of the shortfall in the state reimbursement system.

[subhead]How much does the State normally reimburse?

All state reimbursements are based on an official price list called the tarif de convention. Typical state reimbursements, expressed as a percentage of the tarif de convention, are as follows:

Visits to your registered GP: 70%

Hospitalisation: 80%

Medicines from a pharmacy: 15%, 30%, 65% or 100%, depending on the particular medicine.

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[subhead]Your registered GP

He, or she, is a key person in the state healthcare system and is responsible for your entire ‘care path’ as it is called, and provided you follow this path, you will maximise your reimbursement rates.

[subhead]Serious illnesses

You may be able to qualify for inclusion on an official list of serious illnesses. If accepted, your serious illness would be covered at 100% of the tarif de convention. First of all, discuss your serious illness with your registered GP, who, if agreed, will register your condition with the medical service of your state health office. If the latter accepts you at 100%, they will send you a letter of confirmation and explain that the 100% reimbursement only applies to your specific serious illness.

In certain circumstances involving hospitalisation, a hospital doctor can decide to accept you at 100%.

[subhead]Government cutbacks in state reimbursements

In recent years, the French government has sought economies in social security and this has resulted in a diminution of patient reimbursement levels. The following ‘franchises’ as they are called are levied per person/per year:

(a) At the pharmacy: 50 cents franchise for each and every reimbursable item on the prescription. In addition, note that the French government has removed many medicines from the reimbursable list altogether.

(b) Paramedics (nurse, physiotherapist etc): 50 cents franchise for each treatment – maximum chargeable franchise = €2/day (ie four treatments).

(c) Medical transport: €2 franchise for each occasion – maximum franchise ceiling of €4/day (ie two trips).

(d) When you consult any doctor, your health office deducts a €1 ‘forfait’ from your reimbursement.

[subhead]Complementary health insurance

The choice of a complementary health insurance policy or top-up is an important decision. Most insurance policies are based on a percentage of the tarif de convention. The price you pay for your insurance depends on the percentage level you choose. A 100% policy only means that your reimbursement is capped at 100% of the tarif de convention. This may be enough to cover routine visits to the doctor and normal pharmacy costs, but as soon as you suffer from a more serious condition and need specialist treatment or a significant period of hospitalisation, the actual total cost can be more than the tarif de convention reimbursement level.

Note that no medical questions are asked in respect of top up insurance. This is because the state is bearing the main risk. In general, complementary health insurers offer a range of policies and these have specific terms and conditions. As a result, you need to be fully aware of what your chosen policy covers and what it does not cover.

For example, some doctors are permitted to charge more than the tarif de convention. This excess fee or dépassement as it is known, is never reimbursed by the state (even for those on the serious illness list). The gap between actual cost and your state reimbursement can be substantial, eg certain hospitalisations can be costly. So first of all you need to check whether your doctor in fact charges dépassements and if so, to what extent, if any, your chosen policy covers them.

Daily hotel type charges called forfaits hospitaliers at €18 per day are not reimbursed by the state, nor are private rooms. Also, when a doctor performs a medical procedure, which costs €120 or more, you have to pay a forfait of €18. You should check whether your chosen top-up policy covers these items.

The state pays hospital costs only up to 80% of the tarif de convention (except for those accepted on the serious illness list mentioned earlier). If you have no top-up insurance, this could result in a costly shortfall for you to pay out of your own pocket. As a result, you would be wise to purchase, at the very minimum, a ‘hospitalisation only’ policy, which is offered by some complementary health insurers.

[subhead]State help to buy top-up insurance

On a positive note, state-insured persons may be eligible for financial aid to help purchase top-up insurance. Information concerning eligibility is published in tabular form on the government website www.cmu.fr, and this sets out the income limits which must not be exceeded in order to benefit. You can download an application form on this site and then submit it to your local health office. From 1 July 2013, the threshold limits are more generous. For example, a couple in their 60s, if they were eligible, could each receive €500 aid in the form of an attestation-chèque to present to their top-up insurer in order to benefit.

[subhead]Automatic tele-transmission system

Your state health office issues you with an electronic card called a carte vitale and your top-up insurer with a tiers payant card (where applicable). The two systems work in tandem. Note that all changes in your personal situation must be notified to your health office and to your insurer, otherwise you could find your reimbursements suddenly cease.

[subhead]Official French health website

You will find considerable information on the French state healthcare system on www.ameli.fr – including the list of serious illnesses mentioned earlier. Particular problems can always be discussed as they arise, both with your local health office and with your complementary health insurer.