Your complete guide to healthcare in France

Overview of the French healthcare system

The French healthcare system offers cover for all of its citizens – no matter an individual’s age or financial situation. Within this system, there’s an integrated network of both public and private services, to which people living in France have access.

All French residents are covered through mandatory health insurance contributions – with private insurance available to those who can afford it and want an alternative to the public services at their disposal.

At the very top of the healthcare tree, you have the Ministry of Social Affairs and Health (Ministere des Solidarites et de la Sante), which is in charge of the administrative side of public healthcare in France. It’s then up to different healthcare providers to deliver various primary and secondary services.

In the Euro Health Consumer Index, which started in 2005 and assesses the performance of national healthcare systems in 35 countries around Europe, France was ranked 11th in 2018, and was described in the report as ‘a technically competent and efficient system’.

The French healthcare system is widely regarded as one of the better healthcare systems in the world and its public services tick a lot of the boxes when assessing its benefits. However, its private healthcare serves a purpose and is still a preferred option for many French citizens.

Types of medical care in France and how it’s organised

Most health systems around the world offer a whole range of treatment options – and France is no different. Here, we take a look at the medical care options available to French citizens.

Public health

Santé publique France is a public health agency that combines scientific expertise with input from the state. Its main aim is to improve and protect the French population’s health by anticipating threats, designing health promotion programmes, and responding to public health crises.

As we mentioned earlier in this article, at the municipal level, national public health directives are driven by organisations like occupational health providers, education health providers, vaccination programmes, and so on.

Outpatient care

Defined as care that is provided in clinics, health centres, private practices, and other alternatives that handle treatment outside of a hospital environment. Outpatient care can be provided by doctors, nurses, dentists, and any other licensed health workers. In the French healthcare system, this is usually the first port of call when somebody is ill, unless of course it’s an emergency. Anyone over the age of 16 in France will have a registered primary care physician with their local health insurance fund.

At this point, their physician will establish the level of care that’s required and consider the next stages of the process. They’re also responsible for coordinating that patient’s care and managing their medical file as they go on to receive further treatment.

Inpatient care

This refers to care that is hospital-based and covers a whole array of different services. Regardless of whether the hospital is public or private, they provide general and more specialised care through diagnosing, monitoring, and treating patients with more severe illnesses or injuries.

Some of their main responsibilities include providing emergency medicine, conducting health education programmes, providing care, conducting professional training, and more.

Part of the inpatient care offering is France's regional hospital groups (Groupements hospitaliers de territoires), which became compulsory in 2016. This contract-based programme works between public health establishments in each region to form a strategy that enables equal care for each patient around a shared medical project. The aim is to provide better care at a lower cost – and allow medical teams to collaborate and share activities to ensure each facility has a role to play in the local area.

Specialist care

As previously mentioned, a family doctor is the first point of contact in most health situations. Even if the issue cannot be resolved by this person, they normally create a referral to a specialist with a more appropriate skillset. The exceptions to this are: gynaecologists, paediatricians, and ophthalmologists, which admit patients without referral.

As for which services you can use, this will depend on whether you are relying solely on the public system – or if you have supplementary coverage. To illustrate, seeing a dentist about a painful tooth should pose no problem, but getting orthodontics is not covered by the public system.

Wait times are another significant consideration, with some specialists holding an average wait of three to 12 weeks (ophthalmologists and cardiologists are particularly in demand). At the same time, these queues are better than dozens of France’s EU counterparts, and it’s often possible to get an appointment faster with supplementary coverage or out-of-pocket fees.

Emergency care

Emergency services in France are managed by the Service d'Aide Médicale d'Urgence (SAMU), which is a government organisation. If emergency care is needed outside of a hospital at the scene of the incident, then emergency care will send a mobile emergency and resuscitation team (SMUR), a fire rescue team, or an on-call general practitioner. If this isn’t required, then the individual will take an ambulance to be treated at a hospital. In some cases, patients will also arrive at a hospital needing emergency care themselves, or have been driven by a family member or friend.

At this point, the emergency team at the hospital will take over and administer the appropriate treatment required.

Long-term care and rehabilitation

Long-term care in France can be divided into three main areas:

1. Health and social care facilities: This includes residential facilities for elderly people and those with disabilities. They provide support and care for vulnerable individuals who require some level of assistance.

2. Residential or temporary care: Incorporates various levels of care, such as independent living facilities, retirement homes, assisted-living units, and intermediate services that require only short-term intensive care.

3. In-home care: This is available to individuals that are still able to be quite independent. It can also be called upon to offer respite for full-time carers. Support can be tailored towards an individual’s particular needs, which is determined by a care plan that's developed between in-home support staff.

Pharmacies and medication

There are plenty of pharmacies in France, including those that are open 24 hours. Over-the-counter medicine can only be bought in a pharmacy, where you can also retrieve prescription-only and prescribable drugs. Some medications can only be obtained at a hospital.

The drug supply chain in France is highly regulated by both wholesalers and pharmacies. A monopoly is held by pharmacies on the distribution of drugs dispensed on the basis of a medical prescription.

How the French healthcare system is financed

Although we’ve listed below four areas that contribute to financing the French healthcare system, the main two contributors are the first two – compulsory health insurance and supplementary health insurance schemes.

Compulsory health insurance

The public health insurance system provides basic coverage to French citizens and is funded by tax contributions from income. This system covers the majority of medical bills. However, some people still choose to use supplementary health insurance to cover those bills that aren’t included. Another point of consideration is that a lot of bills need to be paid upfront by the patient, with money being reimbursed at a later date.

Compulsory health insurance schemes focus on health risks that are likely to have the biggest impact on someone’s income – either because of the length of treatment required or the technology that’s needed. This is in accordance with their message to deliver widespread solidarity on the basis of income-proportional contributions.

Supplementary health insurance

The quality of public healthcare in France may be high, but many citizens still choose to top up their compulsory health insurance with supplementary health insurance. This is a sensible way of ensuring that any additional costs and administrative fees are covered.

How much supplemental health insurance costs will depend on the type of policy, and unlike compulsory health insurance, it has nothing to do with income. However, some people receive supplementary group coverage through their employment.

Public financing from the state

Any financing from the state is usually in the form of covering costs for national illness prevention (such as pandemics) and medical research and training.

Patient’s own expenses

Finally, in instances when some of the costs and fees of treatment aren’t covered by compulsory health insurance – and the individual doesn’t pay for supplementary health insurance – then a share of the expenses will have to be paid by the patient, or someone close to them.

Cost of healthcare in France

Such is the modern world that costs are one of our biggest concerns when it comes to medical procedures and investments. While the public healthcare system works wonders in making health services accessible to the population, costs aren’t eliminated altogether. Let’s go over how the system functions from a financial point of view, and what kind of costs patients can expect to incur.

For starters, a large portion of public healthcare funding is extracted directly from salaries and businesses’ income. In 2016, workers paid about 8% of their wages and employers paid around 13% – but these figures range based on year and current legislation in place. In turn, the healthcare system (and associated insurers) covers 70% of general medical expenses,  and up to 100% coverage for serious illness.

Speaking about how funds are distributed, there are three key forms: balance billing, copayments, and coinsurance.

• Balance billing: any allotted fees beyond a preset amount are covered by the customer/patient

• Copayments: a fixed cost paid ahead of a specific medical service

• Coinsurance: a percentage-based payment for a service or procedure with a defined cost.

Diving into the nitty gritty, we can examine some specific examples of fees in the French system:

• A flat €1 fee for visiting a doctor or undergoing a standard procedure.

Does not apply to minors, or women in the late stages of pregnancy.

• Another flat fee applies to expensive procedures (estimated at €120 or more in cost), with patients paying €24.

• Government compensation for medication purchased starts at 15%, but most cases fall under 30-100% rates. The maximum rate applies to costly, essential, and irreplaceable drugs.

• A trip to the emergency room incurs a fee of around €20.

• Hospital stays can be quite expensive, with a daily fee of €20 and 20% out-of-pocket coverage of hospitalisation. Some categories of patients are exempt from paying.

How to get medical care in France

Both residents of France and people visiting short-term should have sufficient access to healthcare, given the nearly 3,000 hospitals operating in the country, and thousands more clinics and private facilities. Most residents of urban areas have access to a general-purpose or acute care facility in their vicinity, while those living in more remote regions may need to drive for up to an hour to see a doctor.

In regards to getting care, there are several possible flows.

• For citizens and residents, the doors to French public healthcare open after three months of living in the country. Additionally, people with official employment in the country and students can initiate the process sooner. The main prerequisite needed is a permanent social security number provided by the government. When you satisfy these prerequisites, you can apply for a carte vitale– a green plastic card with a chip containing key information about you: name, social security details, coverage rate, etc.

Registering for a carte vitale involves submitting a declaration and personal documents, such as a passport (or alternative identification), proof of address, family details, and evidence of income. If your application is approved and you get your green card, you can sign up with a doctor and make your first appointment. Traditionally, care begins with a visit to your chosen family doctor, who can then refer you to other specialists, if needed.

• For tourists from the EU, the easiest way to take advantage of affordable and comprehensive healthcare (at the same level as afforded to nationals and long-term residents) is to obtain and apply for an EHIC (European Health Insurance Card). This card quickly identifies patients and speeds up the processing of care requests in the EU, detailing fees and coverage for services used. The same option should be available to citizens/residents of Iceland, Liechtenstein, Norway, or Switzerland.

There are also about a dozen other countries (e.g. Serbia, Turkey, Morocco) that have signed bilateral social security agreements with France, so their citizens and residents can extend their coverage to various medical procedures in France during their travels. As for everyone else from countries with no relevant agreements with France, they are recommended to obtain an insurance policy from a private vendor that will cover various medical needs abroad.

If you need immediate medical care, call the emergency medical service (SAMU) at the number ‘15’ via any phone. If you don’t speak the local language, you may be able to get a consultation from an English-speaking doctor at some facilities in Paris, such as Hertford British Hospital, but for other areas (especially rural), it will help to ask a bilingual friend or acquaintance to accompany you – or simply rely on translation tools.

For other health situations that are not emergencies, showing up at a doctor’s office without prior notice and reservation will not do you much good, especially if it’s the evening or Sunday.

In terms of reproductive health, women are free to buy contraceptives in pharmacies nationwide – no prescription required. Abortions are also legal in France for women up to 12 weeks along in their pregnancy.

As for giving birth, the system takes great care of expecting mothers. Comprehensive prenatal care with regular examinations, informative materials, and procedures are arranged for after the first prenatal checkup – provided that a‘proof of pregnancy’ document is allotted by the doctor. On the day of birth and the next 11 days, all birth-related expenses are covered by the healthcare system.

Pros and cons of the French healthcare system

The positives and negatives of the French healthcare system are incredibly complex – and a lot of it comes down to personal opinion. However, there are some aspects of the system that are easy to identify with regards to whether that particular aspect is seen as a pro or con.

Pros of the French healthcare system

• Overall, the French healthcare system is efficient and regarded as one of the best in the world. Other than in times of crisis, such as the Covid-19 pandemic, wait times are usually pretty good and patients can receive high-quality treatment quickly

• Generally speaking, French healthcare is affordable and accessible, both for natives of France and residents, people employed and out of work.

• Unlike a lot of healthcare systems around the world, France offers preventative care by encouraging free medical checkups every two years

• If you’re an expat, you can access French healthcare after three months

Cons of the French Healthcare system

• For some people in France, healthcare in the country remains quite expensive

• If you earn more money, you have to pay more tax to fund the compulsory healthcare insurance scheme. Some people deem this unfair if they’re in good health

• Not all of the costs and fees for treatment are covered by compulsory healthcare insurance, meaning some residents are forced to pay for supplementary health insurance as well

• New arrivals to France who aren’t officially employed or undergoing full-time education in the country must wait three months to gain public healthcare benefits.

• Covid-19 had a significant impact on the French healthcare system – as it did on many nations around the world – which health institutions are still recovering from

The French healthcare system: Facts and figures

• Over 11% of France’s GDP is spent on healthcare.1.8% of that goes into prevention

• In OECD countries, household health expenditures are among the lowest in France, averaging around 2% of household consumption. This is in comparison to an average of 3.3% in other OECD countries

• In 2019, there were 1,322,184 hospital employees in the health sector in France. Across the health sector as a whole there are thought to be close to two million people working in the sector, which is roughly 7% of the population

• Life expectancy in France is 86 for females, and 83 for males

• Telemedicine has boomed in France as a result of the Covid-19 pandemic, with 88% of French people who had used the services being satisfied

So, there you have it, the ultimate guide to the French healthcare system. Hopefully, this informative guide by WorldRemit has helped to simplify the nuances of French healthcare. We’ve described in great detail the system’s history, structure, types of medical services, and how it's funded.

If you’d like to find out even more about this topic, then you can continue your learning by looking at the various insightful resources listed below.

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