12 March 2024

MOVING TO FRANCE the French health system


Unlike the UK NHS, health care in France is not free.  

Certain items are not free in the UK either, such as eye care, dental care and medications, except in circumstances due to one's age or financial situation.  Generally, GP appointments, hospital appointments, operations and all free in the UK.  They are not free in France, although there are exceptions for people with certain chronic conditions and those with a low income where the cost is effectively free.

(There are those that would argue that the NHS isn't actually free as people have no choice in paying National Insurance all their working lives in order to pay for it.  A similar system of Social Charges also exists in France.)

The French health system is essentially one where the government contributes part of the cost and it's up to the individual to pay the difference.

Once we had been in France for ninety days we were entitled to apply for a Carte Vitale.  This we did by presenting ourselves at the local office of CPAM, the Social Security service, in Tours.  We first went to ask for an appointment to do this.  At the appointment we had to present the usual set of documents including proof of identity, residence and income.  The Cartes Vitales arrived a few weeks later.  In the meantime we paid for all our health needs and could claim the money back from the UK.

The Carte Vitale is an actual credit card sized card which we now present at every appointment or at the pharmacy.  With this card the French government pay 70% of the cost of everything (but pass that cost back to the UK for its citizens) and it's up to the individual to pay the remaining 30% or take out an insurance to cover it.  This kind of insurance is called Mutuelle Assurance.

(Visitors to France and people on holiday will not have a Carte Vitale and pay the full amount.  In return they receive a claim form to send to the DWP for a refund or claim on their own travel  insurance.)

A consultation with a GP (Médecin Générale) costs around 25€.  With the Carte Vitale 70% of this will be refunded to the individual's bank account by the Government and the rest by the Mutelle Assurance.  People are not obliged to have a Carte Vitale and can pay the full cost of everything if they wish but costs can mount up.  Medications are surprisingly inexpensive and in fact often cost much less than the basic UK NHS prescription charge.  

There are dozens of insurance companies offering Mutuelle Assurance and choosing one can be complicated.  The interesting thing is that, unlike the provision of private health insurance in the UK,  existing medical conditions are not taken into account.  The annual or monthly premium seems to be determined by a person's age and location and no questions about medical history are asked.

One thing we really like about the French system is that having registered with a local GP we can get appointments within a very short time and see the same person each time.  This is much better than the situation in our part of the UK where the best we can hope for is a telephone consultation with someone we may never have seen or heard of before and may never again.  Getting an appointment face to face with an actual doctor in the UK, never mind one you may already know, can be very difficult.

One quirk of the Mutelle Assurance is that people can opt for the level of cover they wish.  It's not cheap and typically will cost a couple our age over £1,500 per year in order to have most things covered.  Whether or not this is value for money is a gamble as with all insurance.  If you never need to be hospitalised it probably isn't but if you do you can end up with a large bill if you don't have Mutelle. 

Another quirk is that health care providers can charge what they wish.  Many will have a set of fees that are in line with recommendations so that a person who has a Carte Vitale and Mutuelle will have little or nothing to pay.  However, some charge more so that Mutelle Assurance providers will offer a level of cover that is much more than the 30% deficit.  

One of the curious things is that the process of referral to a consultant is very different from the UK NHS system.  In the UK a GP will say he or she is referring you to the hospital and, although you might have a choice of hospital, an appointment is made for you and arrives via the post.  In France it's up to you to find a consultant or hospital and make the appointment for yourself.  Most of these appointments can be made using a website called Doctolib where most providers and their fees are listed.

One of the disappointments we have found is that once referred it can take a long time to get an appointment with a consultant or hospital.  It seems that the French system is oversubscribed just like the UK one.  Many people find it impossible to get registered with a dentist in France, just like in the UK.  However, everyone I know who uses the system is full of praise for it and from our experience it does feel very much like a private health system but without the extortionate cost of similar private health care in the UK.

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