Overview of the French Healthcare System
According to the World Health Organization, the healthcare system in France is the best in the world. By all measurements, from the ratio of doctors to patients to the length of wait times, France consistently delivers strong results.
The French healthcare system is premised on universal healthcare. The system is known as the Protection Maladie Universelle (PUMA) It was recently overhauled in 2016 to be more comprehensive and affordable. The previous system, known as Couverture Maladie Universelle (CMU), was also built along the principals of universal healthcare but it was less all-encompassing and tied to employment. Under CMU, a program known as CMU–complémentaire (CMU-C) provided free insurance to those who had a low income or were unemployed. A version of this program continues to this day as a complement to the PUMA program. A such, an estimated 96% of all French residents are covered by the public healthcare system.
In France, hospitals are state-owned and regulated to be not-for-profit. Preventative healthcare is highly valued and all patients are entitled to a comprehensive preventative physical every five years. Alternative healthcare methodologies are respected and if a patient wants to see an alternative practitioner for weight loss or smoking cessation help, the healthcare system supports it.
Costs of the French Healthcare System
It takes a lot of money to run the French healthcare system. Roughly 8% of salaries are automatically withheld to help pay for the system. All citizens pay into the system and the rates which doctors and hospitals can charge are regulated by the state.
A government agency, Agence Nationale d’Accréditation et d’Evaluation en Santé or ANAES, is responsible for issuing recommendations and practice guidelines. This includes treatments and supervision of certain conditions and the evaluation of rates and reimbursement practices.
In general, approximately 70% of healthcare costs, including general practitioners, hospitals, dentists, and pharmaceutical costs, are covered by the government. Patients pay the remaining 30%. Senior citizens and those with chronic illnesses are covered for 100% of their medical costs. Patients should note that, in many cases, they are required to pay upfront and then be reimbursed by the government.
The average cost of an emergency room visit is €100 and patients generally pay only €10. The average cost of a doctor’s visit is €23 without coverage and patients with coverage pay an average of €6.60.
The Differences Between Private and Public Care
Like many countries with universal healthcare, France is facing challenges from long wait times for hospital services and specialist referrals. Holding private health insurance coverage is one way to minimize these waits and receive treatment in a facility that is more private and more comfortable.
Private health insurance can also pay for services not covered by the public system, like consulting with chiropractors and physiotherapists. It can also cover the remaining 30% of basic care costs which patients are expected to pay out of their pocket as a co-pay when they use the public system.
Who is Eligible for Coverage in France?
France’s healthcare system is generous and comprehensive. If you are a legal resident in France you are eligible for public healthcare coverage, regardless of your employment status. This is a big change from the previous system where you had to meet certain employment conditions.
The benchmark for legal residency is the three-month mark. Expats in France must be living there in a “stable and regular” manner. That means that short term tourists aren’t included. Nor are people who don’t intend to continue staying in France long term, as well as people who will be living in France for less than 6 months of a given year. People who spend the winters in the south of France, who use France as a base but travel for more than half a year, or anticipate leaving the country after a few months should stick with private healthcare coverage that protects them no matter where they go.
Healthcare Options for Expats and Foreigners in France
France is considered one of the most expat-friendly places to live thanks in large part to its public healthcare system.
If you’re staying in France for more than 3 months, you can register for French healthcare through your local government office. However, if you’re unsure about your plans carrying private healthcare insurance is a prudent choice. Without some kind of insurance coverage, you’re responsible for 100% of your medical costs.
The first step for people born outside of France to gain access to the public healthcare system is to register for a social security number at the local CPAM (Caisse Primaire d’Assurance Maladie). To do so, you will have to bring your passport, visa (if applicable), birth certificate, lease, and proof of income. You’ll also have to demonstrate that you’ve been in France and living as an expat for at least three months. Copies of utility bills are a good kind of documentation.
While at the CPAM office, you can also register for your national health card or Carte Vitale and get advice on how to register for a local doctor in your neighborhood. Carrying your Carte Vitale with you to any French healthcare appointment is essential. It allows you to be reimbursed directly from the health insurance fund for the consultation or treatment within a week, meaning you don’t need to pay upfront.
Visiting a GP – with your Carte Vitale in hand – is your first step when you need help. You are free to choose any doctor you prefer but you must register with them and declare them your primary physician in order to claim full reimbursement for your visits.
Understanding Specialist Referrals
Knowing how to see a medical specialist in France isn’t always so straight forward. For instance, dentists are always covered within the national health insurance program but at a different reimbursement rate. Their services are more inline with specialist healthcare but you don’t need a referral to make an appointment.
However, you do need a physician’s referral to see most other specialists. Without one, you’ll have to pay a larger co-pay. However, there’s an exception to every rule. In France, you don’t need a doctor’s referral to see a gynecologist, pediatrician or ophthalmologist. And if you’re under 26 and want to see a psychiatrist, you don’t need a referral for that either. But for everything else, from dermatology to cardiology, you have to speak with your GP first.
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