For about a year now I’ve been toying with the idea of continuing my studies, having always wanted to get a Masters degree. After my BA in French, I was actually accepted to a Masters program in the same subject, but decided instead to stay in Europe. It’s a decision I’m glad I made, because in the years since then I’ve come to know myself much better. Ten years ago I thought teaching would be great, but after experience teaching privately, I discovered it’s not something I enjoy as much as I’d imagined. While I would like to teach children in public schools, you have to be a French or EU citizen to even apply for the degree programs. Meanwhile, in the time I’ve been working as a translator and in IT, it’s become increasingly clear that my dream career would be something that combines my loves of literature, languages and computing. This was what I kept in mind over the last year.

Lo and behold, such a dream career does indeed exist: librarian. With today’s information systems, being a librarian now entails having IT knowledge, and a common degree is the Master of Library and Information Science (MLIS). While public librarians may be the first to come to mind, there are other related careers as well: information retrieval specialist / reference librarian, archivist, information subject specialist, knowledge manager, manager of library and information organizations, technical services librarian, Web librarian, and so forth.

I looked at various programs in the US and in France, hoping to stay in France since leaving for more than 3 months would mean losing my long-term resident status and having to start over from zero if I ever returned to the country. But how to finance my studies in France? A friend answered for me: in France, there’s a program funded by the Fongecif for the Congé Individuel de Formation (CIF), or Individual Continuing Education Sabbatical. For continuing education programs of at least 6 months to a maximum of 6 years, on approval of your proposal, the Fongecif can reimburse your employer for your salary, while you do your studies. In other words: you continue to receive your full salary, if it’s less than twice French minimum wage (which is about 1300 euros gross a month), or if it’s more, you get 80 to 90% of your salary. On agreement with your employer, you can return to your company after finishing, or find work elsewhere. There are differing requirements to qualify for the Fongecif depending on your situation; in my case, as a permanent employee (I have a CDI), I need 2 years as an employee, which recently became the case.

As for the program I hope to follow, I jumped out of my chair and started bouncing around my apartment when I discovered that one of the best MLIS programs in France is not only in Lyon, a city I love and miss dearly, but it also offers an option called Systèmes d’Information Multilingues et Ingénierie de la Langue (SIMIL), which translates to Multilingual Information Systems and Language Engineering, with courses in French and English. The school is the Ecole Nationale Supérieure des Sciences de l’Information et des Bibliothèques (ENSSIB), the degree I’m interested in is the MSIB (an MLIS), and they have other programs as well.

The first step is a Fongecif introductory meeting, which I’m going to attend this Thursday. If all goes well, the application process then begins.

In my previous post on French health care, I went over the basics of how things are done here. In this post I’ll compare some statistics, citing Canada and the UK as well since those two countries have often been the focus of recent debate in the US.

The last time the World Health Organisation (WHO) ranked world health systems was in 2000 — they no longer produce rankings since it’s so complex a task. Here are how the four countries fared:
1. France
18. United Kingdom
30. Canada
37. United States
Countries such as Colombia, Saudi Arabia, Morocco and Chile also ranked higher than the US.

Life expectancy has become part of the debate in the US currently. These rankings were taken from the list of countries by life expectancy:
8. France, with an overall life expectancy of 80.87 years
14. Canada, overall life expectancy 80.34 years
37. United Kingdom, overall life expectancy 78.7 years
45. United States, overall life expectancy 78.06 years
The French live nearly 3 years longer than Americans, on average.

Another key issue is pregnancy and childbirth. Here are a few stats taken from Wikipedia’s list of countries by infant mortality rate. The first number is the infant mortality rate per 1,000 live births, and the second is the under-five mortality rate per 1,000 live births:
Iceland: 2.9 and 3.9 (they have the best numbers)
France: 4.2 and 5.2
Canada and the UK: 4.8 and 6.0
USA: 6.3 and 7.8

In France, pregnant women have 3 sonograms and blood tests (one per trimester), with a three-hour blood test around the 4-month mark. All covered at 100%. Anything beyond that’s deemed necessary is also covered 100%. Mothers-to-be get 6 weeks of paid vacation legal minimum before their birth date — it can be extended, for instance if the pregnant woman lives more than an hour’s commute from her offices. They then get 10 weeks after giving birth. Fathers get 11 days of paid vacation (18 days if they’re father to twins or more). Postpartum exams are covered. Parents are given allocations familiales depending on their need; all get a basic “starter” minimum of several hundred euros. There are also allocations to help cover childcare if/when the mother returns to work. Mothers have the option of working 4 days a week instead of 5; fathers can now do this too (but only one member of the couple can do this, and there is a sort of “salary cut” in that a few — less than 10 — vacation days are removed if they choose the “4/5 work week” as it’s called).

All this and per capita, in France we pay half what Americans do: Health Care Spending in the United States and OECD Countries (2007).

From another scientific study, Americans Spend More on Health Care But Are Not Healthier:

The study is the first to use a universal set of standards to compare the quality of health care in the five countries surveyed. The researchers found that no country scored the best or worst overall and that each country was the best and worst in at least one area. The study is published in the May/June 2004 issue of the journal Health Affairs.

Peter S. Hussey, lead author of the study and a doctoral candidate in the Department of Health Policy and Management, said, ”It is well known that the United States spends much more on health care per capita than other countries, and it is commonly assumed that we have the best health care system in the world. However, the results of our study show that the United States performs better than other countries in only a few areas, while performing worse in others. This raises the question of what Americans receive for all of the money devoted to health care.”

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.

I first went to Corsica in 2002, on a trip from Ile Rousse down the coast through Calvi, Porto and to Ajaccio, then back up through the center via the Restonica gorges and Corte, and finally a tour along the Cap Corse to finish in Bastia. I fell in love with the island then — it reminds me of Oregon, in a Mediterranean climate. Wild, mountainous, with a rocky coastline, and people who want to protect its beauty.

Yesterday I returned for a day trip to Calvi, which also ended up including a trip to Calenzana for a wine tasting, and another trip to Ile Rousse! When I ordered my ticket on the phone, the woman had said I’d be in Calvi the whole time. It’s a good thing I double-checked at the ticket office about the time my “boat from Calvi” would be leaving, since there was no boat from Calvi, it was from Ile Rousse. Lesson learned: when you buy a ticket by phone, double-check at the physical (real-life) ticket office, no matter how certain you are of what you heard.

As always I’ve created a photoset of my Corsican trip. Calvi is a gorgeous town, and with our lovely weather yesterday, the colors came through wonderfully. I also tried something new this time, inspired by vistas like the one you see above: panoramas! Click on the “All sizes” icon above these to see larger sizes:
- Panorama of the Corsican coast in the morning sun
- Panorama of Calvi’s port
- Panorama of Calvi from beneath an olive tree
- Panorama of Ile Rousse
- Panorama of the Cap Corse

It was an enjoyable trip, but a bit much for one day. If I’d had more funds available, I’d have paid twice as much for the two-day trip, which includes a night in a Calvi hotel. (All excursions are described here.) Another possibility is the shorter trip, which is the cheapest available at 20 euros, where you only stay for 5 hours rather than 9, but is available on fewer dates than the others. With the longer trip I took, the rough part was being tired and hungry at 6pm, which is too early to eat dinner in a restaurant here, and too late to do anything else with the boat leaving at 7:15, plus we arrived in Nice at 11pm, adding even more to the fatigue factor. For a day trip, it would be better to lose a few “exhaustion hours” by returning earlier (and it would cost less).

I also have to recommend against the wine tasting option. I actually didn’t take it — between the boat departure location and this, I’m really puzzled about what I was told on the phone! I paid for the 49 euro excursion, which does not include the tasting, but I got it anyway. I’m glad not to have paid for it since the domaine’s wines were mediocre. The red “prestige” wine aged in oak vats was strong and yet without body; their fizzy muscat tasted like 7-Up mixed with grape juice; their orange wine was far too bitter even with a piece of honey nougat; only their Cap Corse was decent, but I’ve tasted so much better that I didn’t buy any. As my tastes in wine go, I love Côtes du Rhône and Patrimonio (a Corsican appellation) reds, Oregon pinot noirs, Mâcon and Patrimonio whites, good Cap Corse, limoncello (a lemon liqueur), and have had homemade fruit liqueurs so strong they numbed my throat — and which I enjoyed because they were good, with real body to them. These were table wines in comparison. Even then I wouldn’t serve the orange wine to anyone.

If you want to go to Corsica to taste wine, stay for several days, rent a car and drive through the Patrimonio region. I did this as part of my 2002 trip and it remains one of my favorite experiences. I’ll never forget one vineyard in particular, where I had dinner served with a different wine every time I finished a glass. Every one of those wines was delicious. I’m looking forward to returning to the island again, for a longer stay some day.

I’m taking a short vacation this week — short by French standards, anyway, with 3 days off before the weekend. In my current job, I get 25 base holidays, 1.5 extra holidays due to length of time with the company, 2 “bridge” days, 4 employee RTTs and 6 employer RTTs, for a total of 38.5 paid holidays. Per year. The “bridge” days are to be used when there’s a national holiday on a Tuesday or a Thursday — you can take the Monday or the Friday as a “bridge” (pont). RTT stands for réduction du temps de travail and is related to the 35-hour legal work week in France. Since we work 39 hours a week at our offices, we recover that overtime with extra paid holidays, called “RTTs”. Some are “employee”, i.e. can be used at employee discretion, whereas others are “employer”, i.e. only the employer can set them for the employee, up until October, when the employee can then use them at will. These are mainly used for any unassigned time, since we’re consultants and sometimes, though rarely, don’t have a mission. As for sick days, the concept as used in the US does not exist in France, since if you’re ill enough, a doctor will give you an official form (arrêt maladie) for the number of days you need to stay at home. You’re always paid for those days, and regular paid holidays are only affected by sick days if you miss a large amount of work due to illness (after something like 2 or 3 months’ worth, they might take off a few paid holidays).

So in short, I’m using a few of those 38.5 paid days off to relax! Tomorrow I’ll be taking a day excursion to Corsica, and thought I might share how I pack for day trips in this part of the world. I only take one bag, which is my camera bag. In it I put:
- my camera with a fully-charged battery
- lens cleaning tissue
- my mobile phone, also with a fully-charged battery
- sunglasses
- fold-up brush with mirror (it’s surprising how handy a mirror can come in)
- small packet of tissues, because I’ve had it happen often enough that public restrooms had no toilet paper!
- a few bandages and aspirin just in case
- small wallet — not my usual one — with just one bank card, my carte Vitale (French national health care card), one piece of ID, and a bit of cash (not much)
- prepaid bus card for travel to and from the boat (or train or plane)
- keys to my home, of course
- a pen (always seem to use it when I bring one)
- an extra, small fold-up bag for any purchases

In addition I carry:
- a bottle of water
- snacks

The bottle of water is important, because when traveling in France, you can count on bottled water prices to be much higher than in any regular supermarket. The boat to Corsica is fast, but still takes 2 hours and 45 minutes — you don’t want to be stuck on a boat without anything to drink and where a small bottle of water is sold for €1.50, when you can get them in stores for around 30 cents, or fill your own bottle at home for free!

This way you have a minimal amount to carry, making it easier to explore unencumbered, much easier to keep an eye on your things, and yet you have the right necessities to ensure that all will be well in case anything goes awry.

Photos from my excursion will likely be up on Friday.

A year and a week ago (on 25 July 2008), Kanoko came into my life. His whiskers had been cut off by his abandoners, apparently a common tactic to further disorient cats. A year later, they’re now long and luxurious! Kanoko is a delight, very affectionate and creative, although he does love to play with (read: destroy) my plants and can be a bit too energetic when tackling his “big brother” Grey.

Grey is starting his fourth month with us, still a calm and very matter-of-fact cat. He loves nothing more than to be petted and cuddled, with a deep motorboat purr that starts as soon as he knows he’s going to get affection. He patiently allows Kanoko to pounce on his back and his tail, and gives a harmless but firm swat or two when he’s had enough. His favorite activity is stretching out on the terrace and napping in the filtered sunlight.