Healthcare

This section is no longer updated and remains here for historical reasons. We are getting fewer and fewer questions regarding moving to France; updating these pages would require a huge effort, one that is not justified as our logs show a dwindling visitor count for this particular area. By all means peruse these pages but don't rely on the information unless you verify it with a French embassy or consulate.

The French health care system is managed by the Sécurité Sociale (Social Security, though note that this is in no way equivalent to what social security represents in the United States). Among other things, the Sécurité Sociale deals with the reimbursement of medical expenses. This page presents some information on how the French medical system works. If you are a citizen of a European Union or European Economic Area member nation, or if you are a citizen of Switzerland, you need to obtain a European Health Insurance Card; it replaces the now defunct form E111 and provides temporary medical coverage in France (Ireland has a great page with useful information on the EHIC). If you are a citizen of any other country, check with the French authorities nearest you to determine how you can obtain medical coverage in France.

CAUTION: The French healthcare system is being reformed and some important changes have taken place already. This page will be updated as new information becomes available, but please do not rely on this (or any other non-government) site for definitive answers! As of this writing (March 2005), most changes are already known, but details on certain reimbursements are still outstanding. This page represents the state of affairs as of March 2005.

1. The médecin traitant (new as of 2005)

By July 1, 2005, every person who is 16 or older and covered by the French healthcare system must select a médecin traitant. This is best described as a referring doctor; in most cases, it will be a GP or family doctor, but it need not be so. Any medical doctor, including a specialist, may be selected provided he or she agrees to represent the patient in this fashion. The idea is that the médecin traitant is the one who knows the patient best and to whom the patient turns in case of any medical problem.

If necessary, the médecin traitant is also the one who can direct the patient to another doctor, for instance a specialist. Note that the médecin traitant may recommend a specialist, the choice of which specialist to consult remains with the patient, and consulting a specialist other than the one recommended by the médecin traitant does not change the rate of reimbursement. It is also possible to consult a specialist directly, i.e., without going through the médecin traitant, but in that case, coverage may be reduced. Exactly in what way coverage will differ has not been finalized yet.

For tooth or eye problems, dentists and ophthalmologists may be consulted without a referral from a médecin traitant. The same applies to regularly scheduled check-ups, for instance with a gynecologist. For any given problem, a referral is only needed once; thereafter, it is considered a pre-existing condition and the patient may schedule appointments with the specialist directly. It is then the responsibility of the specialist to keep the médecin traitant informed of the patient's progress.

Though the médecin traitant is usually the family doctor, every member of a family may have a different médecin traitant. For patients aged 16 and 17, the application form must be signed by the parents or whoever has parental authority. The selection of the médecin traitant is by no means final: it is possible to change the médecin traitant at any time. All that is required is to fill in another form. Forms for selecting the médecin traitant are being sent to every household during the first quarter of 2005. The form may also be obtained on-line at the web site of French medical coverage, ameli.fr. The Cerfa number is 12485*01 and you can download the (French only) PDF version from here.

2. Medical Practitioners

General practitioners

These doctors are authorized to prescribe drugs. Except for the comments made under point 1 above, one is free to consult the doctor of one's choice, though in the interest of consistent treatment, it is best to find a doctor one likes and then stay with him or her:

Specialists

Usually, these doctors should be contacted following a referral from one's médecin traitant though it is possible to consult a specialist directly -- but this may mean reduced coverage by the Sécurité Sociale.

Medical professionals and paramedics

Usually, these professionals should be contacted following a referral from one's médecin traitant though it is possible to consult a specialist directly -- but this may mean reduced coverage by the Sécurité Sociale.These professionals are not doctors, but their fees are reimbursable by the Sécurité Sociale:

Medical services

These services are reimbursable when prescribed by a doctor:

Other professionals

Whether or not they are formally recognized, the services of the following practitioners are not reimbursed by the Sécurité Sociale:

3. Hospital Services

Medical Institutions

There are three types of medical institutions: hospitals, clinics, and hospices.

Note that patients checking into a hospital or clinic are required to bring their on night wear, toiletries, toothpaste, shampoo, and so on.

Ambulance Services

The ambulance services are operated by private companies and are solely a means of transportation for sick people between hospitals or between home and a hospital. The vehicles only carry basic medical equipment and should not be confused with the emergency ambulances which are more extensively equipped (see section on emergencies below).

4. Pharmacies

Pharmacists (Chemists) are health professionals that may be consulted for minor health problems which do not warrant a visit to a doctor. They are responsible for checking prescriptions written by doctors in order to ensure that there are no undesirable side effects between medications. The opening hours of a pharmacy are the same as those of any other shop: in general from 9 AM to noon and from 2 PM to 7 PM. Outside of these hours, certain pharmacies are open in case of emergency (see section on emergencies below).

Pharmacies sell three types of products:

Generic drugs which replace name-brand products are available in many cases, though they can only be sold by the pharmacists if prescribed by a doctor. The pharmacist is not authorized to substitute a generic for a brand-name product.

Vaccinations are prescribed and administered by a doctor, but one buys them in a pharmacy.

5. Emergency situations

Depending on the nature of the emergency, there are several courses of action:

6. Sécurité Sociale coverage

The Sécurité Sociale deals with the reimbursement of medical expenses, medical fees, and salary compensation arising in the case of maternity, invalidity, and retirement. The spouse and children of the insured are covered automatically. Others may be eligible to benefit from the coverage, as long as they are true dependents living under the same roof as the insured person. In most cases, additional coverage applies to common law spouses or other family members.

When you register with the Sécurité Sociale (see the Arrival page), you are given an insurance card with your social security number; this number is needed for all administrative matters related to health.

Your Sécurité Social card is a form of medical insurance, but it only provides for a partial reimbursement based on a detailed scale, i.e., the rate of reimbursement depends on the type of treatment received.

The majority of doctors and dentists are "conventionnés" (government-approved), i.e., they have signed an agreement with the Sécurité Sociale. This agreement sets an upper limit to their consultation fees. Doctors who have not entered into this agreement are "non-conventionnés"; they are thus free to set their own fees (honoraires libres), which often exceed the limits defined by the Sécurité Sociale. Even though this only represents approximately 1% of all doctors in France, it is a good idea to check the status of a doctor before making an appointment; this ensures that you can obtain a reimbursement from the Sécurité Sociale for the doctor's fee.

For dental work, routine treatments (such as fillings, scaling, etc.) are normally reimbursable. On the other hand, orthodontics, bridges, and dentures are poorly covered, except in the case of patients less than 16 years of age. Implants are not covered at all by the Sécurité Sociale, though some mutuelles (see point 7 below) partially cover them.

Ophthalmological fees and products are usually well covered, except for eye glasses and contact lenses.

The Sécurité Sociale covers various expenses related to hospitalization, such as the daily charges, pharmaceuticals, transfusions, use of equipment, operating theaters, and delivery rooms. Within certain limits, it also covers medical and surgical fees.

7. Complementary medical coverage

Because the Sécurité Sociale does not cover 100% of health-related expenses, it is very useful to have additional insurance. A complementary medical insurance is called a mutuelle. The cost of a mutuelle depends on the coverage you require. Sometimes, the mutuelle is part of a company's benefit package, but it can also be an individual plan. Check the Yellow Pages under "mutuelles" to find telephone numbers of companies offering complementary medical coverage.

8. Obtaining reimbursement

When you go to a doctor or dentist, you pay them directly and are given a paper called a feuille de soins which indicates the kind of treatment you have received and the amount you have paid. You must then fill in the front part oft the form. If the doctor has prescribed medication, you take the prescription and the feuille de soins to your pharmacie; the pharmacist will dispense your drugs and send the paperwork to the Sécurité Sociale (if you don't need any medication, you must send the feuille desoins to the Sécurité Sociale yourself).

The Sécurité Sociale processes your request and automatically liaises with the mutuelle (if you have one). You will receive the first part of your reimbursement as a direct deposit into your bank account within 6 days. If you have a complementary insurance, the second part of your reimbursement (usually the balance) will be deposited into your bank account 4 or 5 days later. The whole system really functions very efficiently.

During the last few years, an even more efficient system has been put in place: the old insurance card has been replaced with the so-called carte vitale; this looks just like a credit card, and all the data one previously had to write on the feuille de soins is now stored on a small chip in the card. Almost all doctors and pharmacies already have readers that take the information from the card and send it to the Sécurité Sociale electronically. Everything now works as before, except that it takes even less time to be reimbursed than before.

One can even sign up with a local pharmacy for tiers payant (third-party payer) if one has a mutuelle. This means that it is no longer necessary to lay out the part of the cost of medication that is not covered by the Sécurité Sociale. Instead, the pharmacist processes the entire transaction with the carte vitale; the patient pays nothing, and the pharmacy is reimbursed directly.

9. Medical fees and reimbursement rates

New as of January 1, 2005: The patient pays a non-refundable 1 (one) euro per doctor's visit. This means that of the 20 euros charged by a GP for a consultation, only 19 are eligible for refund by the Sécurité Sociale and the mutuelle. The current (March 2005) fees for medical practitioners who are conventionnés are shown below:

These are not typing errors; compared to medical fees in the United States, consulting a doctor in France is almost ridiculously inexpensive. The Sécurité Sociale currently (March 2005) reimburses at the following rates (subtract one euro from each fee prior to applying the percentage):

Note that certain items are only partially, or not at all, covered by the Sécurité Sociale, particularly when it comes to dental work (such as crowns or implants), eye glasses, and do on. The dentist or doctor will advise patiens what the amount covered by the Sécurité Sociale is before performing the work. Certain services, notably those related to hospitalization or serious illness, are covered in full. In France, there are no devastating economic consequences as a result of catastrophic illness.

Finally, both the fees and the reimbursement rates are adjusted periodically. You can obtain the most current figures by calling the Sécurité Sociale office nearest you; check the Yellow Pages under Sécurité Sociale to find address and phone number.

Simply put, when it comes to healthcare, the French system is without a doubt the best we've ever seen because it considers excellent medical care a basic human right rather than a business opportunity. One has to go through a serious illness requiring many weeks of hospitalization to fully realize just how wonderful the French system is.




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This page was last modified on March 12, 2005
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