Health care in France — Basics

Author: fraise

Friday 14 August 2009, in Journal, La France

Overview
France has a public health system called “Sécurité Sociale”, also known as “Assurance Maladie”. It has a standardized, automatic, electronic system for processing bills and reimbursements. Every French citizen enrolled in “sécu”, as it’s called for short, receives a green card with a microchip, called “carte vitale“. The carte vitale contains only insurance-related information; no medical records are stored on it.

It is also illegal to publicly advertise pharmaceutical products and medical services in France. Quote from the linked article: “Direct-to-consumer advertising is forbidden in France for reimbursed and prescription-only drugs, with the exception of vaccines and products used [to help quit smoking].” Pharmacists, doctors, hospitals, etc. can only have office signs, for instance, and there are no TV advertisements for prescription medication.

Sécu covers a range of percentages, up to 70%, of basic care: general practitioner visits, opthalmologists, dentists, prescriptions, and so forth. Emergency care is always 100% covered. Prescription medication for chronic conditions is also always covered at 100%.

To cover the remaining percentage of basic care, you can choose a private health insurer. In France, those known as “mutuelles” (mutuals) are required to be non-profit, and also cannot advertise. They usually cover 100% of the remainder, with some exceptions for optical and dentistry. I happen to have one that covers 100% of everything, optical and dentistry included. For optical and dentistry there are reasonable limits, which means I can get “only” one free pair of prescription eyeglasses per year, for example, and there is an upper limit to the frames’ price.

Going to the doctor, the pharmacy and the ER
For regular doctor visits, when you go to the doctor, you show your carte vitale, which is put in a special reader. Since doctors can set their own rates — the government does not control them, it only sets a maximum amount beyond which it won’t reimburse — you pay for the appointment at the end. Your payment is reimbursed by the sécu at the going percentage, and the sécu transmits the details to your supplemental insurer, who then reimburses the rest per your policy — all electronically and automatically, direct to your bank account if/when you give your account details. (As a tangent, bank accounts are highly secure in France, and so it’s quite safe to give out a “deposit permission”. No one can take money from an account if all they have is the deposit info.)

When you go to a pharmacy, you again show your carte vitale. If you’ve been to the pharmacy before and they have your supplemental insurance information on record, you don’t need to show it again since they link it with your carte vitale. Since prescription medication prices are set by the government, if your supplemental insurance covers them at 100% beyond sécu rates, you won’t have to pay anything. At all. It’s processed automatically. (This is a VERY weird sensation when you’re an American and used to paying — 10 years later and I’m still not used to being given a bag of medication and just walking out.)

For emergency care, an example: three years ago I fell off my mountain bike and nearly broke my ankle. I had to call an emergency number. The firemen — they’re also trained EMTs here and so answer medical emergencies as well as fires — took me to the closest hospital. I was evaluated immediately on arrival. Only once they saw that I was at no immediate risk did the hospital ask me for my carte vitale. The firemen/EMTs hadn’t asked me for anything; they gave the hospital whatever information they needed. I had some X-rays and the wound was cleaned, then I was told to go to my general practitioner for follow-up, and I was sent home.

That was it. No bill. I was given copies of my X-rays and the doctors’ evaluations to show my GP, but nothing more.

My GP then prescribed physical therapy, an ankle brace, and pain medication. All of it was covered at 100%, and the only thing I had to “pay” for was the doctor’s appointment — as described earlier, it was automatically reimbursed 100%.

Paperwork and prices
To show how basic care is documented, I took a photo of my latest sécu and private health insurance reimbursement statements, along with a shot of my carte vitale so you can see what it’s like.

For information, my GP charges 22 euros. A specialist I go to regularly for my preexisting condition (covered 100%, because there’s no concept of “preexisting condition” in France) charges 45 euros. A packet of ten 500mg aspirin costs about 3 euros over-the-counter; it’s free when prescribed. A three-month supply of the Pill costs 27 euros. (The Pill is one of the only prescription medications not to be covered by sécu, so we do pay out of pocket for that — it’s the only prescription med I’ve ever had to pay for.) I don’t know what ER/hospital stays are charged because mine have always been entirely covered.

My supplemental health insurance costs me 20 euros a month. The national health insurance is paid as part of employer taxes; in my case, my employer pays 320 euros a month. That amount is paid directly to national health care, my salary is not affected. Everyone, not just employees, enrolled in sécu is covered, and as you can see from my case, you don’t have to be a French citizen in order to be able to enroll — you just have to work or study in France.

Conclusion
The only thing I have to worry about is having my carte vitale on me. If I don’t have it, it doesn’t matter, I’ll still be covered — I’ve been able to return to a doctor/laboratory/hospital (yeah, I’ve been around) with my card after minor emergencies when I hadn’t had my card on me at the time, no questions asked. I don’t have to worry how much anything costs. I don’t have to avoid doing sports out of the fear I might hurt myself and lose insurance coverage. I don’t have to worry about being able to afford medication. In the 10 years I’ve been in France, my health has honestly become something I only ever think about when I’m ill or injured, and even then all I need to do is call my doctor. I’ve always been able to get an appointment the same day.

32 responses to “Health care in France — Basics”

  1. delaido Says:

    My favorite part about French health care is that doctors do house-calls, at least in Savoie and Haute Savoie. On one occasion I had a moderate (yet routine) allergic reaction needing immediate attention, so I went directly to the doctor’s office. He apologized to me for his previously scheduled appointments that prevented him from visiting me directly! I was flabbergasted. He prescribed me the same medications I receive in the USA, but instead of two bottles of pills, I received only one since the medicine is combined in France. In the USA, these 2 medicines cost $40 with my insurance. In France this medicine costs €1.50 with no sécu.

  2. fraise Says:

    Yes, they do house calls in all parts of France! In big cities it’s pretty uncommon, though you can always ask for it. It’s charged more, but still covered.

    I love the price controls on pharmaceuticals. It is SO wonderful (and rational!).

  3. muffin Says:

    In my opinion, medicine in france is one of the best in Europe.

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