French Health Issues
Lobbying for your healthcare rights in France and the EU
The French Health System is based on state regulated provision of diagnosis, consultation, treatment and aftercare that gives the consumer / patient reasonable choice in selecting providers from either the public or private sectors. It also gives the medical practitioner some freedom to charge fees of his/her choice, though the state health insurance will only reimburse costs based on fixed standard tariffs, usually paying for less than 100% of the standard cost.
Recent legislative changes mean that “in-active” individuals who are citizens of EU countries other than France, below state retirement age and taking up residence in France are not allowed to participate in the French National Health Insurance system once their E106 (or other E form cover) expires. They will be obliged in most cases to take out private health insurance to cover all health risks.
In essence the French system, as set up in 1945, was one where the patient paid for the treatment at the point of delivery and re-claimed a proportion of the cost. Thus is it not, and should never be confused with, a National Health Service, as it is known in the UK. Every patient is, in essence, “private”, and the treatment is the same for all, regardless of their financial circumstances, and the level of their contributions. The state (ie. Ministry of Health) fixes the tariff at which a given consultation, diagnostic test, treatment or medication will be reimbursed. Most residents of France are obliged to subscribe to a state registered Assurance Maladie dependant on their employment status.
Reimbursement for medical expenses is administered by a Caisse d’Assurance Maladie that pays a fixed proportion of the cost. The individual is liable for payment of the remaining part known as the “Ticket Modérateur”. The consumer is free to take out complementary insurance to cover all or part of cost beyond that reimbursed by the Caisse. For many consultations, medicines and diagnostic investigations there is a compulsory “participation forfaitaire” (in effect, a standing charge) for each item which cannot, by law, be reimbursed via insurance top-up policies.
There are also special dispensations for certain long-term, chronic illnesses (ALD) and pregnancy where the national insurance will reimburse 100% of the state agreed charges, less any “participation forfaitaires”. A list of these ALDs can be found here.
Social security French national health insurance site
