French Healthcare -> How Does It All Work?
Pre-Post Note/ THANK YOU everyone for your comments on my last post. I’m still not really sure where we are headed in terms of traveling & this blog (at least for the short term), but I’ve decided, based on your feedback, to continue to post about aspects of our lives in France. I’ll give it a go, and see how it goes 🙂
In our many travels & stays overseas, Paul and I have experienced many different types of health care services from the public hospitals of Hong Kong (which are excellent, by the way) to “medical tourism” in various countries, the NHS service in the UK (towards which I have mixed feelings TBH), the American system (IMO always stressful, unless you happen to be over 65 or have wads of money to throw at it), and now the system in France.
Every healthcare system has it’s pluses and minuses, but I have admit I really LOVE the system here in France. It’s not free (that’s a myth), but it offers a very high quality of care at a very affordable price.
So, for those of you who may be wondering what it’s like, I thought I would write a few posts our experiences here so far, including how the system works here, how much things cost and what our personal experiences have been using the healthcare so far (turns out, I’ve needed it quite a bit). This’ll probably end up being a 2-part series, so hang on for more….
Note/ As with all my healthcare-related post I ask you to keep comments civil. I know this topic can get heated, but let’s keep it chill 🙂
France Offers Universal Healthcare, But It Only Covers ~70% Of Costs
A lot of Americans think that all healthcare in Europe is universal and free, in that you don’t pay anything to see a doctor or get care. In some countries that’s certainly true, but it’s actually not the case here in France.
In France the healthcare system is a mix where most of the costs are covered by the state, but the other part must be paid by the patients themselves (a kind of co-payment if you will), unless they meet certain exceptions.
So for example:
- Hospital Charges -> the state covers 80% of standard costs
- Doctors & surgeons -> the state covers 70% of standard costs
- Auxiliary Medical Care (Nurses, Physios etc.) -> the state covers 60% of standard costs
- Medications -> the state covers 30-100%, depending on the med
For the remaining portion of the costs, the patient either has to pay out-of-pocket or they can buy a gap/top-up insurance (called a “Mutuelle”) that pays for it. Most folks carry a Mutuelle.
Except If You Get Seriously Ill, Then You Are Covered 100%
One of the founding pillars of the French system is the sicker you get, the less you pay.
So, for example if you get diagnosed with a chronic long-term illness (“affection de longue durée”/ALD) such as cancer, MS, AIDS, diabetes, kidney failure etc. then you are covered 100%.
The same is true if you are lower income or cannot afford the care. Then you may apply for Complémentaire Santé Solidaire (CSS) to cover 100% of costs.
So basically, when you’re healthy and able to pay, you are required to contribute a portion of the costs, but if you become really ill or cannot afford it then you don’t have to worry about healthcare costs at all. An amazing, and IMO superbly human-positive approach.
Costs Are Standardized (And Generally Really Inexpensive)
Perhaps the biggest shocker for Americans coming to France is that it really doesn’t cost much to go see a doc even if you pay out-of-pocket. All of this is thanks to the fact that the Government sets official tariffs (called Tarif de Convention) that provide guides and limits on what health care professionals can actually charge.
Here are some standard (conventionné) fees:
- Doctor €25*
- Specialist or complex consultations €46 -€76.70
- Physiotherapist €16.13 (if referred by your primary care doctor)
Now doctors can choose to be either “conventionné (which means they follow the state-regulated rates), or “non-conventionné” (which means they can charge more) so there is some variance in costs, and by extension how much of those costs are reimbursed by the state. Also, certain professions (like dentists) tend to be pretty pricey in general. But for the most part costs are very well-controlled and don’t come anything close to what you pay in the USA.
*Note/ As a reminder, if you’re in the French system, when you visit a regular doc (€25) the state will reimburse 70% of costs (€16.50). If you carry a top-op insurance (Mutuelle) that will typically pay the rest (€7.50). Note that there will always be a weird remaining charge, called a “participation forfaitaire” that cannot be reimbursed by either the state or top-up insurance (e.g. it’s €1 every time you see a regular doc). Kinda curious, but that’s how it works….
Everyone Who Legally Resides in France Has Access
In 2016, the French government rolled out something called “Protection Universelle Maladie” (PUMA)” which allows anyone (French, EU or non-EU, working or retired) access to the state healthcare system after three months of permanent legal residence. There is no discrimination based on sex, age, job-status, wealth or health (pre-existing conditions are not a problem).
So, basically if you are an American and you come here on a long-term stay visa you can apply to access the system after 3 months of living here. You have to carry private insurance before this (which is cheap to get, and required for your long-term visa anyway), but once you are here and in the system, you are good to go.
But You Have To Pay A Contribution (On Income)
Most folks who come to France have some kind of income either through work, retirement, or some other means (rental income, investing income etc.), so when tax time comes around, a portion of this income will go towards social services, which includes healthcare. These are called cotisations sociales and usually end up being “around” 8% of certain income (above a certain level).
The exact $$ you pay however, depends on your situation! Taxation is a complicated subject, especially if you’re an American living abroad. Both France & USA expect you to declare any worldwide income you earn while you are living here, but there’s a tax treaty that outlines where/what you pay in taxes and to which country (you do not end up paying twice). Also there are limits below which no taxes are due.
The nitty-gritty is….gritty…but just know that you will probably end up paying something to be in the system.
Care Is Coordinated By A Primary Doctor (Chosen By You)
Once you are resident in France you’ll want to register yourself with a primary care doctor (“médecin traitant“).
This person will become your first point of contact for all your healthcare needs. They keep track of all your information, do do all your regular check-ups, coordinate all test results, and refer you out to specialized care as needed.
You can typically book appointments online to see them in their office (doctorlib is AWESOME!), and some will even offer home visits for patients who are too ill or infirm to make it to their office (a throw-back to old-style doctoring that I haven’t seen anywhere else).
Note that you are free to chose any primary care physician you want, and you can change your choice anytime. You are also free to seek care outside of your primary doctor, but any meds or referrals not prescribed by your “médecin traitant” are reimbursed by the state at lower rates.
Private Clinics & Teledoc Exist Too
You might be surprised to discover that private doctors and clinics exist in France too. For example there is an American Hospital in Paris which is private and very popular with foreigners. Costs are not mandated by the state (they can charge what they want), but care is still superbly cheap compared to what most places in the US would charge you for similar services.
Also, teledoc-style care exists in France too. It’s a new & growing trend (similar to the USA), but there are now several Teledoc companies (e.g. livi.fr, Mes Docteurs, Hello Care) that offer consultations (and prescriptions) via an online video-call with a registered doc.
If You Are Accepted Into The System You Get The Magical “Carte Vitale”
If you apply, and get accepted into the French system (i.e. your charges are taken on by the state), you get a fabulous green piece of magic called the Carte Vitale. This pocket-sized card is your official French health insurance card and it’s your portal to all French healthcare, everywhere you go.
It works like a dream too. Go to the doctor….swipe your card and you’re done. Go to the pharmacy….swipe your card and voilà, c’est accepté. Plus if you carry a Mutuelle (top-up insurance), you’ll rarely if ever see any kind of bill at all.
Amazingly…it….all….just…works!
Having lived in USA for the past many years, I literally really feel like I’m getting away with theft every time I use my Carte Vitale. And I’m always kind of shocked that there’s no bill coming to grab me in the background after I do. It’s taken me a good year or so to get over the fact that I can just use the card and be confident that my top-up insurance will pay the rest, with zero input or nagging from me. But I think I’ve finally relaxed. I actually go to the doc now, and simply don’t worry about costs anymore.
And You Get Digitized Too
But there’s more too. France has become pretty digital-savvy with all their healthcare stuff. Both Paul and I have an online account (through ameli.fr) that has all our Carte Vitale details, as well as our Mutuelle, our “médecin traitant” and all other pertinent info.
Attached to this we have something called a DMP (Dossier Médical Partagé) which is an online digital repository for ALL our treatments, medications, blood & medical results, as well as a place where we can store emergency contact info & our personal preferences for organ donation (automatically opt-in in France, unless you specifically opt-out) and end-of-life care (e.g. health care representatives, DNR etc.). Any medical practitioner in France can access this, so if we end up in the ER or with another doctor they can instantly access our medical history and preferences. Honestly it’s pretty frikkin cool!
That’s a quick & rough run-down on how the system works. Next up I’ll take you through our personal experiences here, including how long it took us to get into the system & what doctor visits are actually like. It’s VERY different from anything I’ve experienced before.
Color me jealous!
I can’t deny, I’m loving not having to think about medical care or medical costs anymore. It was a major source of stress for me in the USA.
Nina
I think we have a health care industry here in the US, making money is the goal & health care is the product.
I’m glad it’s working out for you guys!
Excellent article and thank you! I hope we can RV Europe someday. I’m just worried about the cost. Obviously not health. Ha. Just other costs.
To be honest, costs of RVing here are about the same as the USA.
I’ve done a couple of cost posts covering the mini-trips we did in Spain & France. Camping costs, diesel, driving are all very similar. For example, even tho’ fuel costs are much higher in Europe, we drive a small (and really fuel-economical) RV, so our monthly costs actually end up a smidgen lower than what we paid to drive “the beast” in the USA. And yeah, health care is no problem at all!!!
Nina
Good stuff, Nina, interesting reading. My friend was embarking on a cruise in Germany and fell, breaking her back. After 8 days in the hospital, and back surgery, she was able to fly home business class so she could be lying down. Her bill had to be paid there, by credit card, and came to 8,000 USD. She was reimbursed by her trip insurance eventually, but if she had been in the US and uninsured the bill would have been at least 100,000K. So it is good to get this information out. I wish there was something similar for us in the US. On another note, I have to thank you for commenting on my loss. So kind of you to notice from afar what is going on with people. I was amazed at how many friends near and far offered condolences. Thank you for thinking of me
That’s incredible, and such a common experience here in Europe. My dad’s cancer treatment, including his surgery, stay in hospital, follow-up and everything else came to less than $7,000, of which he paid only $30 or so (after reimbursements). My mother-in-law however, had to go to hospital for several weeks in the USA and her bill came to over $250,000. Most of it was paid thro’ Medicare (thank goodness), but she still dealing with aspects of the bill over a year later.
I’ll give some more examples of costs in my next post when I talk about my own treatment here.
For your loss….my heart goes out to you.
Nina
Simply incredible. I will be eligible for Medicare in September–never thought I would be so excited to turn 65!! My Mom and her husband are seriously ill, Chuck is on hospice, they need some in home care but can’t afford it as their income is just enough to keep them from receiving any assistance–I’ve beat my head against the wall. Such is healthcare in the US. It’s a sad state of affairs.
Ugh! I’m so sorry for your mom. We’ve experienced the whole mess of home care, assisted living and nursing care with elderly family members in the USA. It’s never easy and it’s so stressful, both financially and emotionally. Many people find themselves up against that same income barrier (making just too much to qualify for aide, yet not making enough to be able to pay for care), and basically have to run down their money to zero before they can get any real help. It’s so sad. I do hope your mom finds a manageable solution.
Congrats on hitting that 65 mark though. What a relief! Less healthcare stress from now on.
Nina
Enjoyable and useful summary of medical care in France. Certainly provides insight into the discrepancies between France and the USA. I do wish we could get the incentives here aligned, so we could leverage our excellent care abilities to make them financially available to ALL our citizens.
I agree. The US has all the elements it needs to do this -> excellent hospitals & doctors, and a system that already works for the general population (Medicare). Making this available to all would really make sense IMO.
Nina
Thanks Nina for another great article seeing the health side of France. As a professional traveler for nearly 30 years, I have been treated in various countries around the globe, especially in the Commonwealth. Now we are back in the USA and do our best to remain healthy in our 80’s following a Mediterranean diet and working out at least five days a week with Cardio and Pilotes classes and weight lifting, which are free, covered by Medicare (Silver Fit).
I have two children who are physicians and we all agree that the USA health system is broken. We have been spared any problems because we are in good health and covered by Medicare. I had bladder surgery a few years ago when we were on a canoe trip in British Columbia. The care was excellent and a tenth of the USA cost. I paid with credit card ($10,000) for two nights in hospital and all operation costs, which was reimbursed by Medicare, as compared with US costs of around $100,000.
As long we we have the Republicans in office, it appears our country is moving more to the Fascist side of things with a vast separation of wealth in the upper classes. Even my wife and I fear the costs of some type of prolonged illness here in Oregon, partly because no one seems to know the costs involved ahead of time. We met an older couple recently in the food lines of a charity where we sometimes help with meals for the poor. I recognized them because the man was quite famous as a local singer at football games singing the National Anthem. Unfortunately, they both had illnesses about the same time and were forced to sell their home to pay the medical costs despite being on Medicare. They were ashamed to be in the food hall and they apologized for taking advantage of a free dinner, as they now lived out of their car.
I have confidence that the USA will eventually turn positive one of these days and put in real universal health care out of necessity, but first we have to get through this election season and move back to the center. I joke that we will move to Canada if Trump gets reelected as my grandparents were from Quebec. Many of my friends are saying the same thing. But…it just shows how frustrating things are these days. My advice…stay in France until things get sorted out.
Thanks again for your outstanding articles. You have a great future as an author and would do well by writing books of your travels and experiences.
The unknown (how much it will cost) is IMO one of the biggest stressors in US healthcare for patients. It certainly was for me. Every time I used the doc in US I had to be sure to ask all the right questions -> am I covered? are they in network? will they balance bill me? how much will it cost? And even then, I couldn’t always get a firm answer.
As you get older those questions become even more difficult (and stressful) especially if you come down with a chronic or long-term illness. Medicare is fairly good, but there are serious gaps even with supplemental insurance. Sadly the story you told about the older couple that you met in Oregon (who had to sell all their assets to cover medical bills) is not uncommon.
I do hope things improve. I love the USA and it will always be my home, but healthcare there is a major struggle. It may be a few years before we return….
Nina
Thanks so much for writing about your experience in France. I find this healthcare topic very interesting and look forward to your next post.
Hi Nina,
Thank you for this comprehensive post. No one is immune to the insanity that is our political climate in the USA right now. One of the hotly debated topics is Universal Healthcare or as some put it, “Socialized Medicine”. You touched on the cost (..”around 8%”) and I got the impression that is just for, for a lack of a better term, medicare in France. The argument extends to the general much higher cost of taxation in Europe compared to the USA partly because of this healthcare system. Have you found that to be true? I ask because the total cost of tax will get lumped into any conversation regarding Universal Healthcare because it fits with their agenda to bash this topic. So I guess, my question is, besides the “around 8%” for medical costs, are there other taxes on top of this in general to live in Europe (France)? What is the total tax a person would pay for a middle to upper middle income family?
I think I get that this isn’t a simple answer but I’d find yours and Paul’s real life experience valuable. Thank you!
The tax question is really difficult to answer, and depends so much on your situation (are you working, retired, etc.)? Do you have investments? Rental Income?
For an American retiring in France, for example, you would not be taxed in France on retirement (SS/IRA) income thanks to the USA/French tax treaty. So your only taxes would be the 8% healthcare contributions, which are only assessed on passive income such as investments, dividends, rentals etc. above ~€9,000. This is decreasing next year to 6.5% on investment income over €20,000. So, that is what you’d pay.
For someone working here however, taxes are different. There are 5 income tax brackets, starting at 0% (below ~€20,000) going up to 45% (above €157,807). Each “bracket” is taxed gradually. So for example if you make €15,000, the first €1 of €10,064 is not taxed (1st bracket), but the remainder is then charged at 14% (2nd bracket). There are also exemptions, based on family size. Ontop of income tax you pay “social charges” of which there are 5 different types in France. These go towards pension, healthcare and other things. They generally end up adding another ~9% or so to the taxes.
If you want to read more about income tax, you can do that here:
https://www.french-property.com/guides/france/finance-taxation/taxation/calculation-tax-liability/rates
That’s kind of a rough a dirty guide, but should give you some idea.
Nina
Thank you. I understand it isn’t a one-size fits all thing so appreciate your response.
What about malpractice insurance? Are French doctors, nurses, med techs, clinics, hospitals, and anyone remotely connected to the medical industry required to carry malpractice insurance. I can’t help but think that is one of the drivers for the high cost of health care in the United States.
That’s a very good question! In France the whole malpractice thing is handled very differently. Medical malpractice here is based on a national no-fault compensation scheme through something called the National Fund for Compensation of Medical Accidents (Office National d’Indemnisation des Accidents Midicaux [ONIAM]). They are in charge of helping the victims who cannot get compensated by the health professional or his/her insurer. This kind of thing is part of the French principle of “solidarité nationale” (national solidarity) = the idea that the whole community supports the costs of risks that are deemed essential to all.
As a result, French doctors do not have to carry anything like the massive ($$$$$) malpractice insurances that US doctors have to carry. It does make a big difference to costs!!
IMO in US healthcare insurance companies are King…not just on the doc side (with malpractice insurance), but also on the patient side (with healthcare insurance). It’s most definitely a big part of the problem.
Nina
Just came across this blog from a forum I was in. My partner and I have been looking at northern Spain to retire early, we have made many visits and are particularly fond of Asturias. However, we too love southern France, particurly just over the Pyrenees. Based on the taxation treaty we may take a serious look at southern France now. One of your responses above eluded to you returning to the US one day, would this be to live? If so why would you spend your later years back in the states? Love the blog and getting lots of valuable information from it. Thank you.
Simple answer -> Medicare. I still love the US and love to travel there, but insurance & medical care are always a concern. Once Medicare kicks in, things become much easier in that sense. But I also love Europe at this point, so I think we will end up splitting our time between the two, eventually.
Nina