French Healthcare -> What Is It Actually Like?

February 2, 2020 by libertatemamo 15 Comments

Following on from my intro post on how French healthcare works, I thought it might be interesting to take you through our actual experience of living it here.

As it turns out we’ve needed quite a lot of care over this past year. My back has given me some serious grief (old disc injuries, all catching up to me), and of course my dad went through his cancer treatment. All this has given us an in-depth look into the French system, and it’s truly been eye-opening

All in all it’s a super easy system to use, and it’s a fascinating mix of both traditional and non-traditional medicine with throw-backs to some old-style doctoring techniques (like home visits for the elderly/infirm) that simply don’t exist in most modern countries anymore. Certain things take longer, others are fast-tracked, and the focus is heavy on prevention. Also, it’s not perfect (no system is), but overall IMO it’s pretty darn nice.

So, what is it actually like? How long did it take us to “get in” to the system? How are French doctors different? What is a check-up actually like? And what’s up with nudity? Ah yes, La France is different….

It Took Us ~8 Months To Get Into The System (But Now We Are Fully Covered!!)

As with all things French it took a while for us to get into the system, but once we were in things just rolled along like butter on a Teflon pan.

As you know from my last blog post, anyone living in France can sign-up to enter the healthcare system after 3 months of continuous, legal residence. Of course it involves the standard French bureaucratic inch-worth of paperwork (application forms, financial/bank history, birth certificates, marriage certificates, proof of residence, proof of address etc.) which you can either mail in or submit in person….and then you wait.

We did our first application by mail, but our paperwork disappeared into never-never land. After months of futile waiting we applied a second time in person at our local CPAM office, and that time it worked! Paul got his acceptance letter & was able to order his Carte Vitale through ameli.fr only ~2 months later whereas mine (because I’m Danish/EU and thus had to go thro’ yet another office) took a few more rounds of paperwork and over 5 months….go figure. Once accepted we also ordered our free carte européenne d’assurance maladie (CEAM)  (also through ameli.fr), thus ensuring we are covered for all our travels throughout Europe.

In addition to our Carte Vitales & CEAM, we carry a Mutuelle that pays all our “top-up charges” (= the ~30% of costs not reimbursed by the state). It’s through a company called April and it costs €85.50/mo (~$94/mo) for both of us. With this combo we literally never see a bill of any kind.

We Have Access To An Incredible Network Of Doctors

We’re very lucky in where we live.

Our house is in a very rural area of France and yet our closest village (10 mins away, population ~2,300) has most of the docs you would ever need including several primary care physicians, an osteopath, several physiotherapists, a dentist, a large (and well-equipped) pharmacy and even a psychotherapist.

Within half an hour we have opthamologists and dermatologists, and only ~1 hour from here we are in Toulouse which is one of the biggest medical research centers in France. There you’ll find the top cancer center in the country (Oncopole) as well as the famous Pasteur Clinique, plus literally every kind of specialist you’d ever imagine.

Not all villages in France have this kind of access, so there’s no doubt we probably have an easier time with docs than other places.

Our Local Access Is Very….Local (And Intimate)

In rural France everyone knows everyone and it’s all very local. I guess most rural situations (in most countries) are like that? But this has been our first real experience living it, and I have to admit it’s quite different from anything we’ve lived before.

We signed up to a primary care doc in our local village just ~10 mins away. She turned out to be a lovely young lady who just happens to live down the road from us (literally 5 mins walk). She’s also a gyno, as well as a primary care doc so she does both (at least for me). And of course we’ve become friends, as folks do in the countryside so we see each other for village festivals, dinners and such.

Which makes life super interesting….and unlike any other doc relationship I’ve EVER had before!

For example, I may go see my doc in the morning for a gyno exam, and then have dinner with her a few days later at her house. It feels a bit erhmmmm…intimate? Yet it’s all very country, very natural and very French.

Yet It’s Also Very Modern

Whenever I need to see my doc I book an appointment online through doctorlib.fr.

This incredible system gives me access to ~100,000 practitioners and over 2,000 clinics all across France (and Germany too, by the way) covering everything from primary docs to specialists. Not all doctors in France are on doctorlib (some still take phone-only appointments, or use their own online reservation systems), but a massive amount are. Plus anyone can use the system whether you’re resident or just a tourist passing through town.

My doc is on there and I can usually get in see her either same day, or within a few days at the most. Once I decide on a date, my appointment gets confirmed with a click, and I’ll get an SMS to remind me. I can also cancel or change my appointment online, or set-up the system to notify me if earlier appointments become available. It’s all superbly slick.

Our Primary Care Doc Coordinates All Our Care 

Our primary care doc (médecin traitant) is the person who coordinates all our care. She is our first point of contact for anything that is worrying us, has all our history, schedules all our regular blood tests and will order additional tests*, or refer us out to specialists as needed.

Her office is located in in a cute little building in our local village (~10 mins away) where she practices together with a few other medics. When I go for an appointment I’ll say “bonjour” to the other patients in the room and then hang out in the waiting area (there’s a set of chairs) until called in. I’ll greet my doc with few “bisous” on the cheek (she’s a friend too, after all) and then go into her office for whatever discussion I need to have.

A typical visit will take 20-30 minutes, although my doc will always go over time if needed. Plus whenever I see her she’ll not only check on whatever is  bothering me at the time, but will also follow-up on things that have been treated or bothered me in the past to see how I’m doing. I always feel VERY well cared for whenever I see her.

Honestly she’s the best doc I’ve ever had.

*Note/ Some testing in France is automatic. For example cervical cancer screenings (all women 25 and up), mammograms (after 50), and bowel cancer screenings (after 50) are all required tests. As long as you are “in the system” you will automatically get notified to get them done as you become of age.

Specialists Can Have Long Waiting Times (But There’s A Short-Cut!)

Most specialists in France are seen via referrals from your primary doc, at least the first time around.

For example, if you need to see a cardiologist you’ll usually go via your primary doc first who will assess what exactly it is you need. They will then refer you out, which ensures there is coordination of your care. Once you have a working relationship with the cardiologist however, you typically just continue to see them as needed (without anymore referrals). They always send any results back to your médecin traitant anyway, so everyone is always in the loop.

There are a few specialists however, that you might decide to see on your own. An Opthamologist for example, if you need new eye glasses. Or a dermatologist, if you need something skin-related. And unfortunately some of these have notoriously long waiting times. For example ophthalmologists seem to have standard ~6 month waits in France, with dermatologists at around 3-5 months.

But there’s a short-cut!! If your issue is urgent, your primary doc can usually fast-track you.

For example for my first dermatologist appointment in France (to check out a suspicious mole), my doc called ahead and got me an appointment within 1 week. The same was true for my dads’ cancer treatment. Once they knew there was a problem he was fast-tracked ahead to the specialist.

And Yeah, Nudity Is Not A Big Deal

Perhaps one of the biggest “shockers” for Americans coming to France is that nudity is not that big a deal here.

So, when the doctor asks you to undress….you ermmm….just do it? There’s no gown, no waiting room, no “privacy area” and usually the doc doesn’t even exit the room or turn around while you’re taking off your stuff.

You basically just strip and get on with it.

It kinda makes sense when you think about it (I mean the doc is going to see it all anyway), but the whole process of getting there can a bit jarring for those cultures that are not used to it. Eh Oui, c’est La France!

You May Not Get All The Tests You Want (All At Once)

Another different thing in French is that the approach to medicine (and veterinary care for that matter) is very different from the US.

For example in the USA, whenever we went to a doc with an issue they would typically order every test in the book, all at once. Tests are money, so IMO some of that is simply for profits sake, but it’s also kind of the American way. Order all the tests, then recommend a bunch of high-tech treatments and get it done. Fast and effective, but ultimately $$$$.

Here in France it’s different. As long as your issue is not urgent or chronic, then they’ll usually take a slower approach. Order a few tests, try a few treatments and “see how it goes”. Some of this is done so as not to waste valuable resources (why order a bunch of tests, if they are not needed?), but it’s also kind of the French way, especially in the countryside. You are expected to have on-going relationships here, including with your medical practitioners, so you don’t need to solve everything in one go.

With my back issues for example, my doc initially ordered X-Rays and some physiotherapy. Then, as things progressed she’s ordered more tests. We’ve talked about long-term treatment plans and what we can do down the line, but in the meantime the approach has been very deliberate and gradual.

And actually, it’s working! It’s taken my American brain a little time to get around the whole “try it and we’ll see” approach, but I’m actually getting better (& more personalized) care than I ever have before, and my back IS feeling the results. It’s all quite revolutionary.

You May Have To Book/Complete Your Tests Yourself

Another kinda oddity here in France is that when your doc prescribes you a test (e.g. X-ray, blood draw, MRI scan), it’s often up to you (the patient) to go get that test booked and done.

For example when I got the script for my back X-Ray from my doc, I had find an X-Ray clinic (I found one 20 mins away), call them up and book the test. Once the test was done the clinic gave me the results on-the-spot (very common in France) which I then took back to my doc for follow-up.

Our annual blood tests were similar. Our doc gave us a script which we then had to take to our local registered nurse**. They drew the blood, sent it off for testing and a few days later both us, and our doc got the full results in-hand.

**Note/ Registered nurses can also come to you! If you are older/infirm you can ask the nurse to come to your house and take blood draws or do injections etc. The cost is only a few euros more, and typically covered by any Mutuelle.

All Prescriptions Are Handled By Your Local Pharmacy

Pretty much every village or town in France has a Pharmacie, and it’s where ALL the med stuff happens.

When you get a prescription from your doctor (or vet) you simply walk down to your local pharmacy and they take care of it. If you’re “in the system” they’ll scan your Carte Vitale and you’ll either have a small payment to make, or none at all. Either way meds are heavily subsidized in France, so they are generally very cheap!

Pharmacists are also really knowledgeable!

Pharmacists train for a minimum of 6 years in France, so they are actually qualified give medical advice, and prescribe certain meds. If you’re sick, for example, and don’t have time or can’t get to see your doc you can always pop into your local pharmacy for advice (another good tip for tourists!). They also carry a bunch of homeopathic and natural medicines which they can advise you on, if you decide to add those to your plan.

As a result you typically get to know your pharmacist pretty well, and he/she will know everyone in your family. For example in my local pharmacy, the pharmacist will often asks how my father is doing when I visit. I also buy so much stuff for the cats there (e.g. syringes, subQ fluids, B-12 vitamins etc.) that they will often ask how my cats are doing too.

An interesting side-note/ Pharmacists in France are trained to recognize wild mushrooms. So if you go mushroom picking in your local forest and want to check that your fungi are safe to eat, you can just pop into your local pharmacy and ask them.

Non-Traditional Meds/Treatments Are Common

In addition to traditional meds, it’s not uncommon in France for your doc to recommend natural supplements, or non-traditional treatments.

For example, you might be prescribed probiotics or specific vitamins. Or you might be recommended hypnosis therapy (my doc actually does this!), or get a script for a multi-week treatment at a thermal bath, called a “cure thermale” (very common for arthritis and other such ailments). It’s part of a “whole body” approach which is very common here in France. Personally I really like this mix of traditional and non-traditional support (plus I’m really, really hoping to get that thermal script).

That’s it for my round-up of the French healthcare system. I feel very fortunate that I’m here and able to get the care I need, especially right now. If you have any questions about the system feel free to shoot below!