A Basic Guide to our
Although our universal health care is regarded as the best in the world, offering a wide choice of general practitioners and healthcare specialists, it is very expensive to maintain. Even though it is provided free or highly subsidized by our government the present deficit is around 6 billion Euros. Once you have experienced our health system you will notice the contrast in standards can be startling compared with other countries.
The system is funded by our working population. Around 20% of an employee’s salary including employer contribution is paid to our government. Of this amount, 12.5% is contributed by the employer while 0.75% by the employee and 7.5% social security tax also collected from employees. This accounts for 60% of the Social Security system, known as Sécurité sociale. Other sources of funding include indirect taxes from alcohol and tobacco. A significant proportion of this money goes towards public healthcare, to which every legal resident has access under the law of universal coverage called la Couverture maladie universelle.
Our system is highly socialized and does not discriminate; everyone is entitled to an equal level and quality of service in both public and private institutions. There are no waiting lists for surgical procedures. Everyone can consult any health practitioner they want in any public or privately run hospitals or clinics.
Until November 2007 all EU expats arriving here were eligible to join our healthcare system. However, now those arriving here and who are not planning to work, are officially retired or in possession of documents which mean their healthcare costs are covered by the government of their original country, will not be allowed to join the system until they reach state retirement age or have lived here for five years. Until then, they have to hold private health insurance. However, the E111 will provide coverage for a certain period of time whilst you find employment.
The E111 coverage is supposed to be at a level equal with French residents covered by the system – and our coverage for maternity benefits is actually very good. You should be aware, however, that our system is a reimbursement system. You pay the doctor, lab or whatever and then you are reimbursed by the state system.
When you subscribe to Sécurité sociale, part of the cost of your medical treatment is covered by the state. However, regardless of cover anyone can consult a doctor or specialist. Similarly, everyone has the right to emergency hospital treatment, although for those who subscribe to Sécurité sociale, the cost is partly reimbursed. The poorest population and those suffering from long term illnesses are fully covered by the government. Once you have affiliated to the system you will receive your carte vitale (green card) which you must take with you whenever you visit a doctor, specialist or hospital, and when you pick up prescribed medicines. The card is placed in a card reader enabling you to later obtain direct reimbursement from the insurance fund, rather than having to submit a feuille de soins. The card itself is not a means of payment, but a means of easier reimbursement normally around a week – direct to your bank account.
Everyone aged 16+ years of age and above is required to have a Carte Vitale, Children under 16 years are included on the card of their parent or guardian.
If you have voluntary insurance, the system will also (normally) pay directly into your bank account that part of the charge that is not fully reimbursable from the social security system, subject to the conditions of cover.
Where there are excess charges (called dépassements) that are payable you may be able to be reimbursed by your voluntary insurer. If not, the costs fall to you.
To qualify for full reimbursement you must register with a médecin traitant. If you attend a cabinet de groupe (group practice) you still have to nominate a particular doctor but should that person be unavailable and you need to be treated by another member of the practice, the rate of reimbursement will be the same.
Children under 16 years of age must have the declaration signed by a parent or guardian but members of the same family can have a different médicin traitant. If the GP or specialist is not your médecin traitant then the rate of reimbursement is only 60 per cent.
You are free to choose your own GP, and can change them at will by submitting a fresh declaration, which will cancel the present one.
The usual rates for professional consulting are 23€ for a médicin traitant for an adult, rates for pediatricians and small children’s visits vary slightly and depend on the child’s age. Of the 23€ paid 1€ is non reimbursable by the patient.
Tarif de Convention
Here all medical treatments from a routine visit to a GP to major surgical procedures have a tarif (cost). Medical practitioners and hospitals/clinics that adhere to this official tarif de convention are defined as conventioné. Those that do not are defined as non-conventioné and can charge what they like, although they do have to display their prices. If you go to a non-conventioné you will have to cover the extra cost yourself.
Perhaps, surprisingly, the vast majority of practitioners (around 97%) are conventioné, and even a private clinic can still be conventioné so ‘going private’ in France does not have the same connotation as that same phrase would in other European countries.
However being treated at a conventioné does not guarantee the amount that you pay, and the reimbursement you receive. Although you may be treated by a medical practitioner classed as conventioné he or she can charge more than the Tarif de Convention provided it is "reasonable and tactful" to do so. So, for example, a surgeon who has extra qualifications or experience in other countries may charge extra for their services. This supplementary charge is called a depassement.
Depassements are not inevitable and are more likely to be applied in some parts of the country more than others. For instance, they are commonly applied in Paris and the Cote d'Azur regions, perhaps because they are perceived to be more affluent. Although a few actes (procedures) by secteur 1 medical practitioners can attract depassements it is inevitable for those in secteur 2 (for the different between the two sectors see Specialistes below). A tarif or their charges should be displayed in their cabinets.
Top up Insurance or Polices Complémentaires/mutelles
Even if you are affiliated to our system a fundamental principle of our healthcare funding is the element of personal contribution. To make up the difference between what the state pays and the cost of treatment, most of us take out an insurance policy to cover the difference (complement). This is called a police complémentaire or mutuelle.
Note: Complementary insurance is not private health insurance.
The cover you choose is entirely up to you - someone who is in good health may only wish for cover for the really expensive items e.g. hospitalisation, leaving a routine visit to the doctor to be funded out of their own pocket. On the other hand someone on regular medication may require a plan that would cover this cost (prescribed medicines are reimbursed 35% or 65% by the state).
If your income after allowances falls below a certain threshold (for example, €16,409 for a couple) and you do not have a police complémentaire, you are eligible to complementary state-funded healthcare, the CMU complémentaire, which will make up the difference, although as a rule of thumb, it will only offer an average level of cover.
Your premiums will depend on age and level of cover required. An important principle with polices complémentaires is that the state must be proved to have paid its share before the insurance will pay the difference. Therefore, you must be affiliated before contemplating the purchase of a policy.
Specialistes are divided into Secteur 1 and Secteur 2. Specialists of all types can be either, 1 or 2 but the latter are more often encountered in some areas of France than others, for example, the big cities, particularly Paris.
Specialistes whose costs are covered by the state
Gynaecologists, ophthalmologists, and dentists are covered by the state without referral by a médecin traitant; young children can also visit any doctor without being referred by a médecin traitant.
Excess Payment for actes medicaux in excess of E91
The excess is 18€ but there are many exceptions such as laboratory tests and X-rays.