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 70% 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 "mutuelles". 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 Practitioner.

In France there is a freedom of choice as far as a GP or Specialist is concerned. In the latter case direct access is usual and referral from a GP not necessary. 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 "conventionn&eacutee". 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 €20. 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.

For the vast majority of those legally resident in France (regardless of nationality) registration with CPAM or other "Caisse" is now obligatory. Registration with 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.

This subject is explored in much greater detail in "Healthcare in France - A Guide for the Expatriate

Tel/Fax: 0033 4 94 85 15 50
email: enquiries@expathealthdirect.co.uk