Health care and health facilities in France are excellent.
France spends a greater proportion of her GNP on health than on defence.
Standards are high; the public and private sectors operate alongside one another and the quality of treatment offered by each one is virtually the same. It should be noted also, that there is no lack of capacity. You will not have to wait for treatment or for a bed and unless you are hospitalised in an emergency, you can go into the clinic or general hospital of your choice. It is worth comment that a ward in a French hospital generally consists of not more than four beds and usually only two in the more modern establishments. Private rooms are readily available. A recent report on world medical care produced by the World Health Organisation placed France before all other countries in the world.
It is worthy of note that establishments and practitioners in France are comprehensively classified by the state. The two principal classifications are Conventionée and Non-conventionée. Conventionée means that the doctor, consultant, hospital or clinic etc. has agreed to observe the price levels negotiated by their associations or in the case of hospitals by themselves with reference to their annual budgets. This price level is known as the Tarif de Convention and upon it the whole system of charging and re-imbursement is based. Both the state service and the French insurance companies use percentages of the Tarif de Convention to define the payments they will make.
Certain establishments and practitioners, especially consultants, are free to charge more than the Tarif but this is limited as it was established in the courts by a case in Nantes that the extra charged must be "tactful and reasonable." These extra charges are called Depassements and are on the increase You should be careful; it is best to ask first before treatment commences.
Establishments that are non-conventionée are unusual and appear to be frowned upon by the system. For example, where CPAM, the organisation that administers the system, pays 80% to 100% of the Tarif in the case of establishments that are conventionée, the Tarif is reduced by 90% for the purpose of making the calculation where the establishment is non-conventionée.
Both public and private establishments may be conventionée and both are excellent. Your doctor will be able to advise you on this matter.
The French system is probably very different from anything you have experienced before. Registration with a doctor is being introduced at the time of writing just as in the UK [For details contact Exclusive’s Free Help Service]. Normally you will have to pay some or all of the bill before leaving and then claim re-imbursement . The doctor you have chosen may keep a record of your visit on his computer, but you keep copies of such things as X-rays, specialists' reports and the like yourself.
The French service however, unlike the UK National Health Service is not a completly free service so even if you are registered with CPAM you need a top-up insurance policy. It should be noted that the French service, plus a good private top-up policy, will give you the best medical insurance possible.
The cost of health care world wide has increased exponentially as the equipment and technology that keeps us all alive longer has become more sophisticated and expensive. France is no exception. The writer suffered an accident in 1994 which resulted in 13 days in hospital. An operation was not necessary but the cost, including scans, was more than £6000. A simple prostate operation costs up to £4000 and open heart or brain surgery can cost £20000 or more.
It would fill many pages to examine the regulation and operation of the French state health insurance system and to fully understand why nearly all French people have a "Mutuelle" as they call it. If you are admitted to hospital you will be asked for your CPAM card and normally for your mutuelle card. This is because there is always a part of the bill to pay which is not met by CPAM.
If you qualify for the maximum reimbursement because you have one of the thirty serious classified diseases, are to undergo significant surgery or have a long term illness, you will only pay for food and extras or "Depassements" as they are called, such as consultants fees in excess of CPAM scales. Normally your share will be between 5% and 10% of the total cost.
If however, you are admitted neither for surgery nor for one of the thirty diseases (for instance cancer) the position is quite different. In such cases CPAM pays only 80% of the scale leaving you to pay 20% plus Depassements, food etc. Your share then, is usually 25% to 30% of the total cost and you may be facing a bill for several thousands of pounds. Add ambulance charges, consultants fees, diagnostic costs etc. prior to admission and then after-care and the figure can become daunting.
Every one of us living in France needs health insurance of some sort. Depending on our circumstances this may take the form of private insurance, French state insurance or a combination of the two. The following sections deal with the rights and obligations of expatriates living in France, your situation if you are insured under the state system and the options open to you in finding an ideal solution. To be insured only under the French State system and to take the risk is not an option. The risk if circumstances go against you is too high. You need a good Top-up as well. |
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