Overview of the French Medical System
Visitors from England, or other European countries can use their E111 or can apply for the new
European Medical Insurance Card (which replaces the E111, E119 & E128), which is onlyvalid for a year. If you intend to stay
longer, or your card has expired, the first step toward medical coverage in France is a consultation with your
local CPAM (Caisse Primaire Assurance Maladie). www.ameli.fr You may need to supply pay slips or proof of employment.
When you have registered with the CPAM, you will probably be issued
with a social security number. If you are not a EU resident you will be issued with the number of your husband / partner.
Once the magic number is issued, you will be sent a “carte vitale”, a green chip card which allows you to automatise
the process of being refunded for your treatment.
Separately you will receive a paper “attestation” that you
are covered with the French system. You will need to present your carte vitale every time you pay for a doctor’s visit
or a pharmaceutical product, so keep it in your wallet! Usually for first visits you need to produce both your carte vitale
and your attestation. The Attestation is used for any cases where the Doctor or Pharmacy is not equipped to read the carte
vitale. You will also be expected to provide a copy of your attestation when you are employed (and for numerous other mundane
administrative procedures) – so keep it somewhere safe!
The social security system pays for up to 70% of your healthcare costs
(e.g. doctors' fees, procedure invoices) and up to 65% of prescription medication. To cover the balance, most families choose
to take out a supplementary health (“mutuelle”). Those families living on a slender income can apply for the CMU (Couverture Maladie Universelle) at their local town hall (“mairie”). This
will allow you 100% coverage for both healthcare and prescriptions, and you will never need to put money forward – the
carte vitale “pays” for you effectively. Emergency medically-necessary operations prescribed by your doctor are
covered 100% (although you may want to pay extra for a private room and facilities such as TV and telephone). There is some
confusion as to which operations are considered medically necessary, so be sure to enquire whether yours will be free to you
or not.
Doctors and other healthcare
providers are grouped into several types. Most often you will consult your local general practitioner (“generaliste”),
but you may also choose to visit a paediatrician (“pediatre”) for your children. Costs vary from €20 to
€23 depending on the doctor. Some doctors, levy a €2 surcharge for a rendez-vous rather than a just 'turn-up'
consultation. Doctors of all kinds are either "conventionne" or "non-conventionne", and charge according to two different
price ranges if they are "conventionne" (secteur 1 or secteur 2). The former are cheaper, so it may be worth enquiring
over the telephone before going to visit them which category they fall into.
Parents should be aware of a fantastic resource in France called
the PMI (Protection Maternelle et Infantile). This is a structure geared towards social and medical
support for mothers and children, and includes free well-baby visits (i.e. not emergency care but regular checkups). Call
your local Conseil General and schedule a “rendez-vous du nourrisson”, or if you are pregnant or newly-delivered,
a doctor or puericultrice (pediatric nurse) will contact you to propose their services. While these services vary from
one "departement" to another, they are well worth investigating. They are often less time-and-money oriented than private
doctors, and are often influenced by more natural healthcare trends, prescribing less and preventing more.
Homeopathic medicine (treating with "granules" or "ampoules" in
the longer term, based on the body's balance) is big in France and is reimbursed by the social security as other standard
medication would be. There are registered homeopathic doctors listed in the Yellow Pages if you particularly want to find
one (including homeopathic paediatricians). However, there are plans in the work to stop government refunding of homeopathic
medicine costs on the same basis as the standard because recent studies have shown that the medication has little effect.
The decision is yours!
