healthcare-in-france

Healthcare in France

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Health insurance and the healthcare system of France explained

The French healthcare system is available to all legal residents, but there are steps to take in order to have to access it. Learn more about how to register with the public health system, which hospitals are best, how to find a doctor, and more.

All legal residents, including expats, are eligible to join the healthcare system in France – which is considered one of the best in the world. In France, healthcare costs are paid by both the state and individual. You will be expected to pay upfront for treatment but will be reimbursed 70% by the state if you’re properly registered. Prescribed medicines may also be reimbursed 15-100% by the state.

Private health insurance can be added to top up coverage. It is required that all private companies offer this benefit to their employees. As part of the French healthcare system, you will also be able to apply for a European Health Insurance Card. During pregnancy, all medical costs are covered by the state and eight weeks maternity leave is guaranteed.

Our guide will help you navigate the French healthcare system, find a doctor, locate the best hospitals, and provide useful information about giving birth in France.

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How does healthcare work in France?

At a Glance: 

  • Health insurance in France is a mixture of public and private healthcare.
  • Patient fees are minimal thanks to state reimbursements.
  • Remember to top up your state coverage with a private mutuelle insurance package!
  • Your carte Vitale tracks all your records and prescriptions.

Healthcare Policy in France

The French healthcare system is often considered one of the best in the world: it’s well serviced with more than one doctor to every 1,000 citizens and helps keep life expectancy at a high 81.8 years. The system is a hybrid which is financed partially by the state and partially by individuals or private insurers. Taxes from employees and employers are collected to prop up the generous state-funded section of the system.

Even though recent unemployment levels and an aging population have put the system under some strain, the French are wedded to their healthcare policy, and it looks unlikely to change any time soon. Having a high-quality healthcare system comes at a price, though. France spends more than 11% of its GDP on healthcare, but this doesn’t necessarily mean it is an expensive system for those using it.

How Much Do You Pay?

Healthcare in France is not free at the point of delivery, so don’t forget your credit card when heading to the doctor’s. You will be expected to pay upfront for treatment, although you will be able to claim most of the money back afterwards.

If you are registered in the state healthcare system, the social security fund will reimburse a certain percentage; private insurers or the individual patient will be expected to cover the remaining costs. The amount reimbursed by the government is usually a generous figure, with an average 70% of expenses being returned to the patient, or 100% in case of serious or chronic illnesses, such as cancer or AIDS. The costs borne by the patients themselves are known as in French.

For example, if you make a doctor’s appointment, the state will usually pay back around 70% of the related costs. As a visit to a primary care physician usually costs around 25 EUR, this means the social security fund will pay 16.50 EUR, leaving the patient with a final bill of 8.50 EUR. Medicine prescribed by a doctor and purchased at a pharmacy can be reimbursed at rates varying between 15% and 100% of the price, depending on how effective or necessary the medication is deemed.

The French system works according to the so-called principle of solidarity: the sickest will usually pay the least, which prevents them from being financially disadvantaged because of poor health. When it comes to costs not paid for by the state, most French citizens take out an additional policy to top up their coverage. This insurance plan can normally be sourced from a non-profit company and is known in French as l’assurance complémentaire santé or mutuelle.

The policy normally costs between 50 and 60 EUR a month and will mostly cover the rest of the bill, but you will still be left with some charges. These insurance companies are forbidden, for example, to pay for the 1 EUR charge for a consultation, and most policies refuse to cover you for injuries obtained during extreme or dangerous sports. However, if you are employed in France, you are very likely to be well covered nonetheless: since the start of 2016 it has been compulsory for private companies to offer this kind of top-up insurance to their employees.

Are You Insured?

If you are covered by France’s universal healthcare system, you will be protected by the 2016 PUMA scheme (Protection Universelle Maladie). If you are a legal resident in France, you will be eligible for health coverage, regardless of your employment status. This marks a change from the previous system, where dependents were insured via the wage earner’s state coverage. Once you are in the system, you should be covered for as long as you live in France, regardless of any changes in employer, address, or family status.

However, to qualify for this coverage, you must still meet the residency requirements. An expat moving to France will not be immediately introduced into the insurance pool. To qualify, you must have lived in France for three months or be working in the country, as well as planning on living in France in a “stable and regular” manner for at least six months of the year.

By entering into the French state healthcare system, you will also be able to apply for a European Health Insurance Card (EHIC). This entitles you to emergency treatment in any EU country without having to pay any upfront fees.

If you are an EU citizen and have an EHIC card from your home country, you can use this for a while to pay for some healthcare coverage. Your EHIC card will work in France for three to five years, but it will only be valid for urgent treatment in case of emergency. It’s therefore still advisable to sign up for some kind of official insurance scheme if you are staying in France on a long-term basis.

The Carte Vitale

Once you are in the French healthcare system, you can get yourself a carte Vitale. The electronic carte Vitale was introduced to replace paper prescriptions, store patients’ records more effectively, and streamline the state system. The card contains the administrative information needed by medical professionals for sorting out prescriptions and medication. It is linked to your insurer, which means that information can be relayed directly and reimbursements should be completed within around five days. There is no charge for applying for a card, and it should be provided through your insurance company.

Once you have a carte Vitale, it’s important to keep it up to date. You need to update your card around once a year or if you change any details such as employer, address, doctor or whether or not you are a parent. To update your card, you need to use a terminal, which can be found at various health facilities as well as at your insurer’s office or a local pharmacy.

Going Private

With such a reputable state-funded system, full private health insurance is deemed unnecessary by most residents of France. Private coverage will be much more expensive than the hybrid system and certain doctors only work within the state system, meaning you may not be able to use them if you have private health coverage.

Very few people opt for full private coverage in France as this is a far more expensive alternative to the hybrid social security scheme. However, those that do take this route can expect a tax break as they will be exempt from health-related tax contributions as they don’t have to pay in to a system they will not be using. This group can therefore expect to save around 8% on any annual income over 10,000 EUR.

While the option of going private may seem to make sense for those earning enough, it is worth bearing in mind that pre-existing conditions may not be covered. Moreover, if you are not already an EU national, you will not be automatically eligible for an EHIC card, as you would be under the state system.

Early retirees are one of the few groups who may need private healthcare — at least on arrival — in France. This group must be legally residing in France to qualify for the state system. Therefore they need to have lived in the country for three months with sufficient income and health coverage. To cover this three-month gap, EU nationals can use their EHIC card, but private healthcare may also be an option worth considering.

Healthcare in France

You’re in Good Hands

The French healthcare system has been ranked the best in the world several times in the World Health Organization annual rankings and is consistently named in the top five. Both French citizens and expats benefit from a comprehensive network of hospitals, doctors, dentists, and other medical facilities. As of 2014, there were more than 200,000 medical doctors working for state hospitals and private organizations and looking after the health of all French residents. The country spends an above-average amount on healthcare (almost 12% of its GDP). The patients themselves spend comparatively one of the lowest amounts on healthcare, most of it being subsidized by the government.

Different Types of Hospitals

France is a world-leader in medical research, and state hospitals are well equipped with modern facilities and treatment methods. All hospitals are clustered into groups by region (groupe hospitalier), and lists can be found online — all public hospitals in Paris, for example, can be found on the website of the Assistance Publique for Paris. They are then categorized into general hospitals (centre hospitalier), local hospitals (centre hospitalier regional), and university hospitals (centre hospitalier universitaire).

Dentists usually operate in private practices, but most routine procedures are 70% covered by social security. There are also a number of walk-in clinics for mental health issues (Centres Médico-Psychologiques) and social work (Centres Médico-Psycho-Pédagogiques), which are often half public, half private.

Go to the Doctor, or Let the Doctor Come to You

Private hospitals are called cliniques and often specialize to a higher degree than state hospitals. Some private clinics cooperate with state hospitals, so their specialized resources may be used to support public hospitals if necessary.

It is customary for French families to have a family doctor whom they consult first for all common ailments.

The French universal healthcare system (known as Puma) covers the majority of medical costs for any individuals who are working in France or have been resident for at least three months — although it is still possible to be covered before this if you have worked a certain number of hours or paid a certain amount in contributions. After three months of working, you can also receive daily cash benefits if you have to take medical leave.

You pay by carte vitale, which is your health insurance card for the public healthcare system, and which will cover the majority of the costs. If you do not have a carte vitale,every doctor can issue you with a bill for the treatment you have received, which you can then use for insurance claims.

Most doctors sign an agreement with Sécurité Sociale (social security in France) which regulates the fees they can charge for certain treatments. This is important when choosing a doctor: anything charged above this limit will not be reimbursed by Sécurité Sociale (although it might be by a supplementary health insurance provider).

You’re Well Taken Care of as a Mother-to-Be

First things first: A minimum of eight weeks of maternity leave is compulsory for every mother.

Sixteen weeks of maternity leave (congé maternité) are optional, usually six weeks prenatal and ten weeks postnatal. For a third child, this amount increases to 26 weeks — eight weeks prenatal and 18 weeks postnatal. It also increases if the woman is expecting twins or triplets. The additional weeks of congé maternité are unpaid, but families are eligible for benefits during this period. Men receive a paternity leave period of 11 consecutive days for the birth of one child, or 18 for a multiple birth.

Mothers-to-be who have been with their employer for more than a year are free to take up to two years out for bringing up their child (congé parental d’éducation). After this period they must be re-employed in the same position or a similar job. Under Puma, all medical costs during the pregnancy are covered, even if they are not directly related.

Best private and public hospitals

At a Glance:

  • The French social security system will contribute to any fee incurred by your hospital stay, but you may still have to pay some of the charges — particularly if you are in a private clinic.
  • Dialing the European Emergency number 112 or the French SAMU number 15 will put you through to ambulance services.
  • You cannot be denied emergency care if you are not insured, although you will be expected to shoulder all the costs.

No one ever wants to use hospital or emergency facilities, but if the worst should happen, it’s important to know how to get help. The good news is that if you are covered by the French social security system, you will not have to worry about call-out fees or paying for treatment, as France’s hybrid insurance scheme will usually cover most of the costs.

To find out how to get medical insurance coverage in France, read our article about the French healthcare system.

Headed to Hospital: What to Do If You Are Seriously Ill

There are over 2,600 hospitals in France, so there is probably one not too far away if anything should go wrong. Follow the signs to your closest CHR(centre hospitalier régional — regional hospital), CHS (centre hospitalier spécialisé — specialist hospital), CHU (centre hospitalier universitaire — university hospital), or clinique privée (private clinic): any of these facilities should be able to treat you. It is worth noting, however, that not all hospitals and clinics have emergency facilities, so it is important to check what your local hospital can and does treat before you set off in a crisis.

There are two types of hospital in France: private and public hospitals. Patients with social security can be admitted to both, and the state will reimburse the costs incurred at the official rate. However, private clinics are allowed to set their own fees, which may be higher (or lower) than the official price. This means that you could be left with a bigger bill once the state has paid its share, so it is important to check their prices before you check in.

If you stay in a public hospital while you are in France, the cost of treatment should be covered by the French social security system. However, costs incurred by your “bed and board” will not be covered, and private insurance is needed to top up state provisions (e.g. a single room for your stay). Some senior physicians or surgeons at public hospitals can also set their own rates, similar to private clinics in general, and the difference in costs is usually not covered by a public healthcare policy.

After being admitted to hospital you will need to show your carte Vitale (French health insurance card), a European Health Insurance Card, or some proof of insurance. If you are entirely uninsured, you cannot be denied healthcare in France, but you will be expected to pay for it entirely yourself.

Even if you are insured, there may be some cases where you have to contribute to your treatment when you receive it. If this happens, you will be given a feuille de soins (a document containing information on the medical costs incurred), meaning you can be reimbursed for any care you have paid for by your healthcare provider later on.

Don’t Speak the Language? Pas de Problème!

If you do not speak French but are living in the capital, you are in luck. There are several hospitals in Paris with bilingual doctors and medical staff. Institutions such as the American Hospital of Paris are linked to the US government and follow US American medical practices. However, such institutions are frequently privately run, so they can be more expensive than public hospitals. It is therefore important to get an estimate and check with your insurer before you choose this option.

Outside of the capital, bilingual hospitals may be harder to find, and it cannot be guaranteed that your doctor will speak English. In this case, it is advisable to bring a French-speaking friend with you or to learn some basic phrases related to your illness prior to your visit.

Call in Case of Emergency

In an emergency, it is important to know which number you need to call for assistance. Dialing the European Emergency number 112 will put you through to an emergency line, where you can request medical assistance alongside police or fire services. There will probably be an English speaker in the call center, so this might be the best place to ring if you are not confident with your French.

Dialing the number 15 will put you through to SAMU (Service d’Aide Médicale Urgente), the organization designed to deal specifically with medical emergencies. For other emergency services in France, calling 17 will put you through to the police and 18 will give you the fire brigade.

Staff answering SAMU phones frequently have medical training or are even doctors themselves, so they can offer proper advice in a crisis. There is no national ambulance service in France, but SAMU operators can arrange for a private ambulance to pick you up if required. The costs for this service will be covered by the social security system. However, it is worth noting that if an ambulance taxi is used, you may have to pay up front and be reimbursed later.

Your Local Hôpital

There are a lot of hospitals in France, and extensive lists and rankings of these institutions are published online. The political weekly paper Le Point publishes a league table of the best public and private hospitals in France every year, with the comprehensive list covering most facilities across the country. It’s best to work out where your closest hospital is when you first arrive in France, so you will have no trouble locating it in an emergency.

Here are some of the major public hospitals in France’s cities.

Cannes

Centre Hospitalier de Cannes

Grenoble

Centre Hospitalier Universitaire

Groupe Hospitalier Mutualiste

Lille

Centre Hospitalier Régional Universitaire de Lille

Lyon

Centre Hospitalier Centre-Sud

Hôpital Pierre Wertheimer

Marseille

Hôpital de la Timone

Hôpital Saint Joseph

Montpellier

Centre Hospitalier Régional Universitaire

Mullhouse

Nice

Centre Hospitalier Universitaire

Paris

APHP – Hôpital Cochin

Hôpital Saint-Antoine

Pité-Salpêtrière Hospital

Strasbourg

Hôpitaux Universitaires de Strasbourg

How to find a doctor or dentist

At a Glance:

  • On moving to France, you need to find a doctor to act as your médecin traitant.
  • Doctor’s fees are low and can be claimed back through social security and private top-up insurance.
  • For routine procedures, dentist’s fees are capped at reasonable rates, but these can spiral for rarer or cosmetic treatment.

Getting sick abroad is made all the worse when you are not able to visit your trusted family doctor or dentist. But rest assured, you are in safe hands in France as the country is home to one of the best healthcare systems in the world.

From the outside, the system can seem a little complicated, though, so here are some guidelines for getting hold of a doctor and going to the dentist.

A Doctor for Life

When you sign up for health coverage, you need to pick a so-called “treating doctor” or médecin traitant. It doesn’t matter whether your médecin traitant is a specialist or a general practitioner, and you can change doctors at any time by notifying your insurance provider. Children usually have the same médecin traitant as at least one of their parents, but this is not obligatory.

Your médecin traitant will keep track of your medical history and can refer you to specialists or other doctors if needed. This is called the “coordinated care pathway” system. Following this system, you are only meant to make appointments with doctors recommended to you by your official médecin traitant.

While it is possible to bypass the official recommendations and source your own specialist, the reimbursement rate will be lowered if you do not follow the pathway system. This means only 30% of the costs will be refunded, instead of 70%. There are exceptions to this rule if you want to consult an ophthalmologist or gynecologist: you will be spared any financial penalty for finding your own doctor in these cases.

Doctors’ offices are found all across France and are known as cabinets. These practices are often joint enterprises between multiple doctors. You can ask at your nearest pharmacy where the closest office is, or you can locate a doctor online.

If your French is still pretty rusty, you may want to consider picking an English-speaking doctor for your stay in France. If you live in a rural area, this can be challenging, but most big cities will have bilingual doctors. Both the Australian and American embassies in France have published a list of English-speaking doctors on their websites. For expats who have more confidence in their French, you can source a local doctor using the PagesJaunes and searching for “médicin”.

Cash for the Consultation

While most fees will be reimbursed, do not forget your wallet when headed to the doctor’s as some costs will need to be paid upfront. These fees are fairly low, and a consultation with the doctor costs between 25 and 30 EUR, which the state will reimburse you for at a later point.

However, there will most likely be an additional 1 EUR fee, which must be paid by the patient. This small, extra fee is called a participation forfaitaire or forfait and is charged for every medical action: for example, if you have a consultation and an x-ray on the same day, you will be charged 2 EUR on top of the fee your social security will cover. These charges are capped at 4 EUR per day and 50 EUR in total for the entire year, so you won’t be racking up big bills if you get sick.

You can usually pay for your treatment by cash, check or debit card, but it is increasingly common for practitioners to be linked up to a centralized system which allows patients to use their carte Vitale instead. This card is issued by the state insurance company and means the patient does not have to pay at all. Instead, the money is taken directly from social security, skipping the reimbursement stage.

Out of Hours but Not Out of Luck

If you get sick out of ordinary working hours, you will not be able to simply turn up at the cabinet. Like shops, pharmacies, and all official services in France, doctors’ offices are typically shut in the evenings and on Sundays. However, if you are in need of assistance after hours, a rota system will be in operation — at least in big cities — to ensure a doctor is available.

The system known as Maisons médicales de garde (MMG) means the on-call doctor will be regularly rotated, so it is best to phone your local gendarmerie (police station) or the SAMU emergency number (15) to find out which office you need to call. There is information available online for those living in Paris as well as some other major cities. At an MMG, there is usually an extra fee incurred with treatment out of office hours, but this can often be reimbursed through France’s social security system thanks to top-up insurance.

It is worth noting that the out-of-hours doctors are not forced to stay on duty, meaning only about 15% of the population are served by the MMG late-night system. Especially in rural areas, there is often no out-of-hours medical care, except in case of accident or emergency.

There is a secondary out-of-hours service run by SOS Médecins. This call-out service may be able to help you if you live within their operating area and dial the emergency number 112 or their own direct line. The latter can be reached by dialing 3624, although you will be charged at a rate of 0.15 EUR per minute.

Keeping Your Pearly Whites in Good Shape

Basic dentistry (e.g. consultations, cavities, tooth extractions) will be covered by the state, but many more complex or cosmetic treatments will be pricier and the patients will have to shoulder the costs themselves.

France’s hybrid health insurance system means the state has lobbied for low prices on routine treatment. A simple consultation will cost you 23 EUR, while a tooth can be extracted for less than 35 EUR. These prices are capped if you are covered by the state insurance system, and you can claim 70% of the fee back from the government. Your private top-up insurance should cover the rest.

Fees for non-essential or infrequent treatments can vary considerably, and the state will not give you any money back for cosmetic procedures such as teeth whitening. There are official guideline prices for non-regular procedures such as fitting a crown or having a tooth implant, but dentists are under no obligation to stick to this fee.

This means having a tooth crowned could cost you anywhere from a few hundred to more than a thousand euro, despite the recommended price being less than 110 EUR. It is also worth noting that the state insurer will only reimburse you 70% of the official treatment price: you would receive around 75 EUR after having a crown fitted even if you had paid well above the 110 EUR price tag. The rest of the bill will need to be picked up by a private insurer or the patient themselves.

Therefore, dentists are legally required to produce an estimate for how much their work will cost prior to treating you. There are also websites which offer reviews and price comparisons of individual practices, although it is still best to get an official quote before you book in your treatment.

Children are offered a free dental check-up every three years between the ages of 6 and 18, and these dental exams are even compulsory between the ages of 6 and 12. You will receive a letter from the Caisse Primaire d’Assurance Maladie, which entitles your children to their regular examination. Take this letter to the dentist and you will not be charged for the consultation.

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Giving birth in France

At a Glance:

  • The French state provides excellent care for expecting mothers, which continues after the birth for both mother and baby.
  • Births in public hospitals are entirely free of charge for French residents, who are obliged by law to have health insurance.
  • A newborn does not necessarily obtain French nationality, despite being born in France.
  • Abortion in France is both legal and paid for by the state.

Since January 2016, expats can easily apply for state health insurance, as the government installed the universal healthcare system known as the Protection Maladie Universelle, or rather PUMA. In any case, French residents are required by law to have health insurance.

The First Hurdle: The Pregnancy

France has a brilliant reputation for expecting mothers, with endless check-ups and services available throughout and beyond the pregnancy. First things first: A pregnancy test is called a test de grossesse and is available in most pharmacies.

Once you’ve confirmed the good news, it is advisable to choose a gynecologist who is also an obstetrician, known as an accoucheur. This will allow you to stay with the same doctor throughout the entire pregnancy. It is common for the sex of the baby to be revealed during the first ultrasound scan, so if you want to leave this unknown, specifically inform your gynecologist before the scan.

Following the first ultrasound scan, it is crucial to complete the document you will be given — the declaration de grossesse (proof of pregnancy). This is needed to claim social security and health insurance coverage. Once the forms have been received, mothers will be issued with a pregnancy guide, as well as dates for medical examinations and maternity leave.

Following the first check-up, mothers are entitled to a further eight examinations preceding the birth, which will include additional ultrasound scans and antenatal classes. For this purpose, your gynecologist will also provide you with a maternity record book, called the carnet de santé maternité, where each medical examination will be recorded.

Mothers will receive three payments from the CAF — the Family Allowance Fund. These will be the congé maternité during the pregnancy, followed by the congé parental and congé pathologique after the birth.

The Big Day: Giving Birth in France

Many women in France choose to give birth in hospital: their gynecologist helps them to reserve a place at their clinic of choice and to find a midwife in cases where the mother does not have an obstetrician gynecologist. Public health insurance for hospital births — excluding deliveries in private hospitals — covers all expenses for the first twelve days spent in hospital, meaning the birth will likely be completely free. Furthermore, mothers discharged within five days — the average hospital stay is three days — are entitled to home visits from a midwife.

Alternatively, mothers who choose to give birth at home should be aware that it is tricky to get full insurance in this case, due to the risk that a home birth entails. Nevertheless, your health insurance will partially cover the costs of giving birth at home, and the birth will still take place with a midwife present.

Cause for Celebration: After the Birth

Following the birth, babies must be registered within three working days. This is known as the déclaration de naissance and can be done at the local town hall, known as the mairie. The child may acquire French nationality at birth, providing one of the parents is also French.

Otherwise, non-French children who are still residing in France at 18 years are eligible to obtain French citizenship. Additionally, children who have lived in France for over five years from the age of eleven are also eligible to become French nationals upon turning 18 years old.

Mothers in France are entitled to a postnatal examination within the first eight weeks following birth, and, if necessary, physiotherapy. The child will then continue to have examinations up until they turn six years old. Local clinics also provide public services such as vaccinations and health and nutritional advice.

Unwanted Pregnancies

In France, abortion is legal up until twelve weeks along in the pregnancy, or 14 weeks since the last menstruation cycle. However, abortions at later stages are nevertheless possible, if two physicians confirm that the birth puts the child or mother at severe risk of death or an incurable illness. Providing the mother is registered with French social security, the termination at public hospitals will be paid for by the state.

The morning-after pill, known as la contraception d’urgence, is also available and can be purchased at pharmacies without a prescription.

Parental Leave

Mothers in France are legally required to take a minimum of eight weeks off work and are entitled to receive their full salary for the first 16 weeks of maternity leave. This increases to 26 weeks for mothers who are expecting a third child or more. Mothers expecting a multiple birth are entitled to twelve weeks’ leave in the case of twins, or 22 weeks if they are expecting triplets. Fathers are entitled to eleven days of fully paid paternity leave, or 18 days in the case of a multiple birth.

InterNations GO!
by InterNations GO!
08 January 2019
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