French Healthcare -> How Does It All Work?
Pre-Post Note/ THANK YOU everyone for your comments on my last post. I’m still not really sure where we are headed in terms of traveling & this blog (at least for the short term), but I’ve decided, based on your feedback, to continue to post about aspects of our lives in France. I’ll give it a go, and see how it goes 🙂
In our many travels & stays overseas, Paul and I have experienced many different types of health care services from the public hospitals of Hong Kong (which are excellent, by the way) to “medical tourism” in various countries, the NHS service in the UK (towards which I have mixed feelings TBH), the American system (IMO always stressful, unless you happen to be over 65 or have wads of money to throw at it), and now the system in France.
Every healthcare system has it’s pluses and minuses, but I have admit I really LOVE the system here in France. It’s not free (that’s a myth), but it offers a very high quality of care at a very affordable price.
So, for those of you who may be wondering what it’s like, I thought I would write a few posts our experiences here so far, including how the system works here, how much things cost and what our personal experiences have been using the healthcare so far (turns out, I’ve needed it quite a bit). This’ll probably end up being a 2-part series, so hang on for more….
Note/ As with all my healthcare-related post I ask you to keep comments civil. I know this topic can get heated, but let’s keep it chill 🙂
France Offers Universal Healthcare, But It Only Covers ~70% Of Costs
A lot of Americans think that all healthcare in Europe is universal and free, in that you don’t pay anything to see a doctor or get care. In some countries that’s certainly true, but it’s actually not the case here in France.
In France the healthcare system is a mix where most of the costs are covered by the state, but the other part must be paid by the patients themselves (a kind of co-payment if you will), unless they meet certain exceptions.
So for example:
- Hospital Charges -> the state covers 80% of standard costs
- Doctors & surgeons -> the state covers 70% of standard costs
- Auxiliary Medical Care (Nurses, Physios etc.) -> the state covers 60% of standard costs
- Medications -> the state covers 30-100%, depending on the med
For the remaining portion of the costs, the patient either has to pay out-of-pocket or they can buy a gap/top-up insurance (called a “Mutuelle”) that pays for it. Most folks carry a Mutuelle.
Except If You Get Seriously Ill, Then You Are Covered 100%
One of the founding pillars of the French system is the sicker you get, the less you pay.
So, for example if you get diagnosed with a chronic long-term illness (“affection de longue durée”/ALD) such as cancer, MS, AIDS, diabetes, kidney failure etc. then you are covered 100%.
The same is true if you are lower income or cannot afford the care. Then you may apply for Complémentaire Santé Solidaire (CSS) to cover 100% of costs.
So basically, when you’re healthy and able to pay, you are required to contribute a portion of the costs, but if you become really ill or cannot afford it then you don’t have to worry about healthcare costs at all. An amazing, and IMO superbly human-positive approach.
Costs Are Standardized (And Generally Really Inexpensive)
Perhaps the biggest shocker for Americans coming to France is that it really doesn’t cost much to go see a doc even if you pay out-of-pocket. All of this is thanks to the fact that the Government sets official tariffs (called Tarif de Convention) that provide guides and limits on what health care professionals can actually charge.
Here are some standard (conventionné) fees:
- Doctor €25*
- Specialist or complex consultations €46 -€76.70
- Physiotherapist €16.13 (if referred by your primary care doctor)
Now doctors can choose to be either “conventionné (which means they follow the state-regulated rates), or “non-conventionné” (which means they can charge more) so there is some variance in costs, and by extension how much of those costs are reimbursed by the state. Also, certain professions (like dentists) tend to be pretty pricey in general. But for the most part costs are very well-controlled and don’t come anything close to what you pay in the USA.
*Note/ As a reminder, if you’re in the French system, when you visit a regular doc (€25) the state will reimburse 70% of costs (€16.50). If you carry a top-op insurance (Mutuelle) that will typically pay the rest (€7.50). Note that there will always be a weird remaining charge, called a “participation forfaitaire” that cannot be reimbursed by either the state or top-up insurance (e.g. it’s €1 every time you see a regular doc). Kinda curious, but that’s how it works….
Everyone Who Legally Resides in France Has Access
In 2016, the French government rolled out something called “Protection Universelle Maladie” (PUMA)” which allows anyone (French, EU or non-EU, working or retired) access to the state healthcare system after three months of permanent legal residence. There is no discrimination based on sex, age, job-status, wealth or health (pre-existing conditions are not a problem).
So, basically if you are an American and you come here on a long-term stay visa you can apply to access the system after 3 months of living here. You have to carry private insurance before this (which is cheap to get, and required for your long-term visa anyway), but once you are here and in the system, you are good to go.
But You Have To Pay A Contribution (On Income)
Most folks who come to France have some kind of income either through work, retirement, or some other means (rental income, investing income etc.), so when tax time comes around, a portion of this income will go towards social services, which includes healthcare. These are called cotisations sociales and usually end up being “around” 8% of certain income (above a certain level).
The exact $$ you pay however, depends on your situation! Taxation is a complicated subject, especially if you’re an American living abroad. Both France & USA expect you to declare any worldwide income you earn while you are living here, but there’s a tax treaty that outlines where/what you pay in taxes and to which country (you do not end up paying twice). Also there are limits below which no taxes are due.
The nitty-gritty is….gritty…but just know that you will probably end up paying something to be in the system.
Care Is Coordinated By A Primary Doctor (Chosen By You)
Once you are resident in France you’ll want to register yourself with a primary care doctor (“médecin traitant“).
This person will become your first point of contact for all your healthcare needs. They keep track of all your information, do do all your regular check-ups, coordinate all test results, and refer you out to specialized care as needed.
You can typically book appointments online to see them in their office (doctorlib is AWESOME!), and some will even offer home visits for patients who are too ill or infirm to make it to their office (a throw-back to old-style doctoring that I haven’t seen anywhere else).
Note that you are free to chose any primary care physician you want, and you can change your choice anytime. You are also free to seek care outside of your primary doctor, but any meds or referrals not prescribed by your “médecin traitant” are reimbursed by the state at lower rates.
Private Clinics & Teledoc Exist Too
You might be surprised to discover that private doctors and clinics exist in France too. For example there is an American Hospital in Paris which is private and very popular with foreigners. Costs are not mandated by the state (they can charge what they want), but care is still superbly cheap compared to what most places in the US would charge you for similar services.
Also, teledoc-style care exists in France too. It’s a new & growing trend (similar to the USA), but there are now several Teledoc companies (e.g. livi.fr, Mes Docteurs, Hello Care) that offer consultations (and prescriptions) via an online video-call with a registered doc.
If You Are Accepted Into The System You Get The Magical “Carte Vitale”
If you apply, and get accepted into the French system (i.e. your charges are taken on by the state), you get a fabulous green piece of magic called the Carte Vitale. This pocket-sized card is your official French health insurance card and it’s your portal to all French healthcare, everywhere you go.
It works like a dream too. Go to the doctor….swipe your card and you’re done. Go to the pharmacy….swipe your card and voilà, c’est accepté. Plus if you carry a Mutuelle (top-up insurance), you’ll rarely if ever see any kind of bill at all.
Having lived in USA for the past many years, I literally really feel like I’m getting away with theft every time I use my Carte Vitale. And I’m always kind of shocked that there’s no bill coming to grab me in the background after I do. It’s taken me a good year or so to get over the fact that I can just use the card and be confident that my top-up insurance will pay the rest, with zero input or nagging from me. But I think I’ve finally relaxed. I actually go to the doc now, and simply don’t worry about costs anymore.
And You Get Digitized Too
But there’s more too. France has become pretty digital-savvy with all their healthcare stuff. Both Paul and I have an online account (through ameli.fr) that has all our Carte Vitale details, as well as our Mutuelle, our “médecin traitant” and all other pertinent info.
Attached to this we have something called a DMP (Dossier Médical Partagé) which is an online digital repository for ALL our treatments, medications, blood & medical results, as well as a place where we can store emergency contact info & our personal preferences for organ donation (automatically opt-in in France, unless you specifically opt-out) and end-of-life care (e.g. health care representatives, DNR etc.). Any medical practitioner in France can access this, so if we end up in the ER or with another doctor they can instantly access our medical history and preferences. Honestly it’s pretty frikkin cool!
That’s a quick & rough run-down on how the system works. Next up I’ll take you through our personal experiences here, including how long it took us to get into the system & what doctor visits are actually like. It’s VERY different from anything I’ve experienced before.