Your interactive family guide to France as recommended by local mums | Last updated 3 months ago

How the French Health system works

How the French Health system works

France has a system of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world.

  • The French government ensures that its population has access to care and decides what type of care is reimbursed, and to what degree (normally around 70%)..
    Health authorities plan the size and numbers of hospitals. They decide on the amount and allocation of technical equipment (such as MRI, CT scans…).
    The  system is funded  by obligatory health contributions on salaries - paid by employers, employees and the self employed; partly by central government funding; and partly by users who have to pay a small fraction of the cost of some health care that they receive.

    Securite Sociale

    Once you have become part of the French social security system, youll be issued with a Carte Vitale (green card)
    This is your right to French health insurance - an affiliation to CPAM (Caisse Primaire dAssurance Maladie).
    The Carte Vitale  covers the likes of (some) surgery, maternity & fertility, examination/treatment by GPs, dental care, prescription drugs and X-Rays
    You will need it at every health appointment (doctor, clinic, hospital, etc) and you will normally receive reimbursement for treatment directly into your bank account within five days.
    NB. A Carte Vitale has no expiry date but must be updated (mise à jour) annually.

    The temporary card whilst waiting for  a Carte Vitale is called a feuille de soins  This is recognised by CPAM as a legitimate medical payment.

    GPs (médecins généralistes)

    Most General Practicitioners are self-employed. Patients are free to choose the GP the want, and sign up with him or her, as their personal doctor. Patients have to pay a  fee for any visit to a GP (around 23 euros in 2011). Most of this will be reimbursed by your state-run health insurance provider,
    Virtually all GPs in France are "conventioned", i.e. they have signed a contract with the national health insurance scheme to provide their services in the framework of the national health service, at the rates agreed nationally.

    Hospitals

    There are two sorts of hospitals in France: hôpitaux when they are state run, and cliniques when they are privately run. Most private cliniques are state approved, and can therefore work for the national health service. Many specialists work in both state run hospitals and in private clinics: since they are self-employed professionals, they can sell their services to whatever hospital or clinic will pay them.
    Both GPs and specialists can refer patients for hospital treatment if is is deemed necessary; and within the framework of the health service, they can send them for treatment in either a state-run hospital or a private clinic, whichever they consider to be best for the purpose, or to provide the fastest service.
    Normally, you will not be charged more than 18 euros for a stay in a French hospital (for board and lodging).

    Accident and emergency

    A&E services (les urgences) are part of the national heath care system. All cities and large towns have a service know as the SAMU, which is the emergency ambulance service. Paramedics and medics from the SAMU are called out in the event of accident or emergency, and provide on the spot assistance before transporting the sick or injured to A&E or other specialised units at the nearest hospital providing them.

    Specialist health care

    Specialist health care is provided by  specialists in all branches of medicine  in towns and cities throughout France. Specialists charge higher fees than GPs but  official rates are agreed with the national health service, which form the basis on which patients are reimbursed. A large number of specialists apply tariffs that are higher than the official rates; in such cases, patients will either be reimbursed according to the standard rate, or else at a higher rate, if their health insurance provider provides for this.
    Visits to specialists in France are only reimbursed by the health care system at the full rate if the patient has been referred. You can visit any specialist you want, without getting referred by their own GP; but if you do, the cost of their specialist visit will only be paid back at the basic GP visit rate, however much they paid.
    The main exception to this is for dentists: dental care is covered by the health service, but has its own tariffs and reimbursement rates.

    Many specialists divide their time between consultancy work in their own surgery or group practice, and hospital work. Some work exclusively in their own practice, and some work exclusively in hospitals or clinics. It is important to remember that specialists working outside state hospitals do so as self-employed professionals, offering a private service that is paid for by the patient, and then rapidly reimbursed by the state health insurance scheme.

    Medicines

    GPs and specialists prescribe medicines and then bought at a pharmacy. Unlike at a GPs, you only have to pay the part of the cost not covered by the state health care system. This depends on the nature of the prescription but the basic rates are: 100%, 65% (the normal rate) 35% and not-reimbursed.