THE FRENCH HEALTH
The funding of
health in France is based mainly on obligatory social insurance schemes. For example
both employer and employee contribute a share. In respect of the employee this appears
as a statutory deduction on the salary slip. These contributions are passed on to
one of various "Caisses". The actual "Caisse" will depend on
the trade, profession or business of the individual. Approximately 78% of health
funding comes from this source.
For most expatriates
coming to live in France and particularly those who are retired or have taken early
retirement they will register with the "Caisse Primaire Assurance Maladie"
(CPAM) of which there is a nationwide office network.
The other underlying
principle of health funding is that it is a contributory system. What this means
is that although there are these (quite high) obligatory contributions this does
not cover all medical and dental costs. 70% is the norm. It is up to the individual
to pay the balance either directly or via a "top up" insurance. These
are called "polices complementaires" and the providers are referred to
as "organismes complémentaires". Only in the cases of those defined
as the 30 most serious diseases/illnesses and major surgery will 100%, or nearly
100% of the costs, be met by CPAM. Even being diagnosed with one of these diseases
eg; Parkinsons Disease does not automatically mean full reimbursement. It will depend
on how advanced the condition is and it being certified with CPAM by the Medical
In France there
is a freedom of choice as far as a GP or Specialist is concerned. It is now necessary
to register with a doctor ("médicin traitant") and referrals to
specialists will usually be via the "médicin traitant". There is
also a choice of hospital and the state and private hospitals complement each other.
There is no discernible difference in the standard of care. Indeed it can be less
expensive in a private hospital because the bureaucratic and administrative costs
are often lower and the private hospitals will not have a teaching function.
The cost of each
individual treatment is determined by the "Tarif de Convention". Medical
Practitioners and hospitals/clinics (the majority) that conform to this tarif are
described as "conventionnée". Those that do not are "non
conventionnee" and can charge what they like. There are healthcare and pension
benefits for those who are "conventionnee." A routine visit to a GP "conventionnee",
for example, is set at 22 €. CPAM will meet 70% of this cost and balance is
paid by the patient or his insurer. The patient pays the doctor directly and applies
to CPAM for a reimbursement. In the case of potentially expensive treatment such
as hospitalisation then arrangements can be made for CPAM and the "mutuelle/police
complementaire" to pay direct. If a patient chooses "non-conventionnee"
treatment CPAM will only reimburse 10% of the tarif.
It gets worse!
Although this tarif is the standard, Practitioners are allowed to charge more than
this provided it is "tactful and reasonable" and Specialists, the tarif
of many being €27, will often do so. This surcharge is known as a "depassement".
Many Specialists will charge at least double the tarif. However CPAM will only refund
70% of the tarif. It is factors such as "depassements" that can affect
the choice of a "top up" policy of which there is a bewildering array.
This is only a
brief summary of healthcare system in France. It is a complex subject and individual
queries are welcomed.
CPAM can be as complicated as the nature of the organisation itself. Many reforms
have been introduced in recent years and there are more in the pipeline. These
are outlined in "Healthcare in France - A Guide for the Expatriate.
Use the navigaton
bar to find out about rights and affiliation to CPAM.
is explored in much greater detail in "Healthcare in
France - A Guide for the Expatriate
Registered Office in France
Address for Correspondence
Rte de La Motte
Siret No: 478 715 147 00029
ORIAS No: 10053292
Tel/Fax: 0033 4
94 85 15 50