9. Receiving Health Care in France

1. 9.1. General Practitioners
   9.2. Consultants
   9.3. Prescriptions
   9.4. Emergency Treatment
   9.5. Hospital Treatment
   9.6. Maternity Care

---

9.5. French Hospital Treatment

9.5.1. Admission

There are both private and public hospitals in France.

Most private hospitals (cliniques privées) are accessible on broadly the same terms as a public hospital, with very few operating completely outside of the public sector.

Public hospitals may be a general or local hospital (CH), a regional hospital (CHR), a specialist hospital (CHS), or one linked to a university (CHU).

Admission procedures are as follows:

i. Legally Resident

If you are admitted as an in-patient to hospital then they you will need to produce your health insurance card (your carte vitale), the notice (attestation) you will have received confirming your entitlement to health care, together with proof of your voluntary insurance policy, or CMU complémentaire.

In all these cases the eligible costs of treatment will be met through your local health authority - your Caisse Primaire d'Assurance Maladie (CPAM).

If you are in possession of 'E' form certification, such as E106 or E121, you also use your carte vitale or attestation, and your eligible costs will also pass through your local CPAM.

ii. Visitor

If you are admitted as a visitor to France, then you will need to produce either your European Health Insurance Card, or private health insurance policy.

iii. No Health Insurance

If you have no health insurance, and it is an emergency, you will still receive treatment, although you will be responsible for the costs.

If it is not an emergency, you are likely to be asked to make pre-payment for the treatment.

You may be able to make application for assistance under the Aide médicale d'Etat (AME), a system of support for those on low income and not legally resident in France, but who have been living in the country for at least three months.

iv. Accident at Work

If you are hospitalised as a result of an accident at work then your employer should have provided you with an accident report form, which you should also present to the hospital.

The hospital will use this to provide you with a letter (bulletin d’hospitalisation) that will then secure your entitlement to sickness/accident pay during your absence from work.

v. Transport

In general, if it is necessary for you to be provided with transport to receive your medical treatment these costs are reimbursable provided it is authorised by your doctor or specialist.

The rate of reimbursement for transport is 65% under the national insurance scheme, with the balance reimbursable from your voluntary insurance if you have one.

vi. Private Room

You do not have an automatic right to a private room, but you are entitled to ask for one, and to be offered one if space is available. The social security system will not pick up the additional cost of the room, unless required for medical reasons, but you may find your voluntary insurance policy or private policy covers the extra cost.

9.5.2. Charging Policies

There is no uniform set of charges for French hospitals.

Public hospitals will charge the official rate, but the charging policies of the many private clinics are similar to that of doctors and consultants.

That is to say, some have agreed to operate the official tariffs, whilst others impose their own rates, often in excess of those prescribed by the government.

Nevertheless, some private clinics offer treatment at rates lower than those in a public hospital, so do not assume that a private clinic in France is always the more expensive option!

In addition, there are also public hospitals where consultants have been granted the right to take private patients and charge in excess of the official rates.

These extra charges are called dépassements d’honoraires, and they are becoming more and more frequent.

Clearly, whichever consultant or establishment you choose, (or need) to attend will have an impact on the charges for which you and your insurer may be responsible.

As a general rule most hospitals and clinics recover the eligible fees directly from the social security system and the voluntary insurers, so you are only faced with having to pay non-eligible costs at the end of your stay.

This process of recovery direct from the insurance system is called le tiers de payment.

9.5.3. Reimbursement Levels

Sadly, the system of reimbursement is becoming ever more complex as the government tries to eek out ways of pushing more of the costs onto the patient or insurers, and consultants impose extra charges.

It is, therefore, only possible to give an overview of reimbursement levels, as there are so many variables it is unwise to generalise.

The main ineligible cost is that of the forfait hospitalier, a daily charge of €18 that is the responsibility of the patient. If you have voluntary health insurance then these costs will be met by them.

In addition, the social security system does not cover the costs of a private room (unless required for medical reasons), telephone calls, television or those charges in excess of the official rates. If you have a voluntary health insurance policy or private policy, then these costs may be covered by that policy.

There are several circumstances where the level of reimbursement from the social security system is at the rate of 100% of eligible costs.

The main beneficiaries of ‘full’ reimbursement are those suffering a long term or major illness, pregnant women, those benefiting from free health insurance through the CMU Complémentaire, and those hospitalised as a result of an accident at work.

Once again, however, there needs to be a health warning about ‘eligible costs’ because the same exclusions as those above apply.

In addition, patients benefiting from 100% reimbursement are also obliged to pay a basic charge of €18 where the costs of hospital treatment exceeds €90.

You will need to read your voluntary insurance policy to see if these costs are covered.

9.5.4. Hospital League Tables

Each year the French magazine 'Le Point' publishes a list of the top public hospitals in France, evaluated on the basis of the treatment of different types of illness.

League tables such as this do need to be treated with some degree of caution, but you can find more details at Le Palmarès 2008.

Le Point also list the top 50 hospitals in France.

---

Next: Maternity Care

Back: Emergency Treatment