An Introduction to Private Healthcare System in France

An Introduction to Private Healthcare System in France

The healthcare system in France is recognised as one of the best in the world and although not complicated for French people, it can be a bit confusing at first for people who move to France from the UK. In this article our aim is to give an overview of the system so you know roughly what to expect.

That said, it is important to give a ‘health warning’ (excuse the pun!), that each CPAM (Caisse Primaire d’Assurance Maladie) office has a certain amount of autonomy to apply their own rules. As a result, it’s important to establish what your rights may be in the specific area you’ve chosen to live, before deciding to make the move, especially if you have ongoing or long-term health issues.

How the healthcare system works in France

In most instances the French social security system doesn’t pay for the full amount of medical treatment. There are however some exceptions to this, for example when there is a long-term, serious illness, but it’s safest to assume that you will not receive a full refund. What normally happens is that the social security system refunds a fixed percentage of a cost that they have determined for the treatment you have received. See below, ‘Where it gets a bit complicated’ for more detail.

Generally speaking, when you visit a GP in France, you’ll be asked to pay a bill of 23 €uros, of which 70%, less a processing fee of 1€ will be reimbursed by the state. The same rough percentages are true for most hospital treatments.

Private Medical top-up insurance

In order to cover the remaining 30% of your costs, in France, most people take out what’s called a mutuelle/complémentaire santé. A mutuelle/complémentaire santé is an insurance policy which will pay the part of your healthcare expenditure that isn’t covered by the state. This type of private health insurance cover shouldn’t be confused with private health care insurance in the UK. It is completely different and isn’t underwritten on your state of health for acceptance.

We plan to include an article about mutuelles/complémentaires santé over the next couple of weeks, but in the meantime, suffice to say that when you take out your contract, it’s really important to shop around because prices vary enormously. What’s more there are various ‘bells and whistles’ that can be added to policies if you need them, but be careful not to be misled into paying for them if you don’t need them.

For people on very low incomes there is the possibility to join the CMUC (Couverture Maladie Universelle Compleméntaire), which is the equivalent of a mutuelle/complémentaire santé, but it’s provided free of charge by the state in France.

Where healthcare in France gets a bit complicated

Real prices

Many medical treatments in France are provided by professionals who have the right to set their own prices, however, when it comes down to how much you get paid back by the state, there are fixed rates. The social security system sets a pricing standard and whether or not your chosen doctor or specialist adheres to these prices is up to them. In many cases, you’ll find that the prices charged are exactly as fixed by the social security, but if you’re in any doubt, it is well worth checking. Highly specialized treatments are often charged at a premium and you can find yourself unexpectedly out of pocket if you don’t do your homework.

As you’ll discover in our article about mutuelle/complémentaire santé policies, there are ways of covering costs that are over the pre-determined social security limits, but always check your own situation.

Long-term illnesses

Long-term illnesses or Affections de Longue Durée (ALD) in France are commonly reimbursed in full, but not always. Again, this is a complex area and while some of your associated treatment might be fully refunded, there may be others that aren’t. Needless to say, again, this is something you should seek advice on so you know what to expect.

Where to go to get help

The CPAM (Caisse Primaire d’Assurance Maladie) office is the place to go to get help and to find out your rights. Like anything in a foreign language, it can be complicated at first to understand, but you should persevere and at the start, take someone with you who speaks good French if you need to.

The capital city of each department has a large CPAM office and is the place that deals with the processing and decision-making surrounding the healthcare system in France at a local level. Some smaller towns will also have a permanent CPAM office, but very small towns and villages will normally have some sort of CPAM presence from time to time. The best place to find out when a CPAM representative is due to come to your town or village is to ask at your Mairie.