1. Overview of Health Care System in France

1. 1.1. System Under Pressure
   1.2. Health Insurance System

1.2. Health Insurance System in France - L'Assurance Maladie

Health care in France is funded by a dual system of health insurance comprising:

• A State controlled health insurance social security system, called l’assurance maladie and;
• A separate voluntary health insurance system called assurance complémentaire provided through mutual organisations and private insurers.

Whilst the social security system picks up most of your health costs, you will need to take out voluntary health insurance to cover those medical costs that will not be picked up by the State.

We will review voluntary ('top-up') insurance in later pages but, for now, we just consider the State funded part of the system.

Accordingly, in order to obtain access to the health service in France, and obtain reimbursement of costs, you need to be registered with l’assurance maladie.

Historically, l’assurance maladie comprised a number of private or mutual insurance bodies who collected insurance premiums from their clients, which were then used to pay for the costs of health care.

They developed after the Second World War as a series of mutual schemes between employers and employees, and the present arrangements still bear the hallmarks of this approach.

Although the insurance funds continue to be ostensibly ‘private’ organisations they now operate under the supervision of the Government, who have ultimate financial responsibility.

Accordingly, the funds are now effectively a branch of the state social security system.

At a local level the General Fund is administered by the Caisse Primaire d’Assurance Maladie (CPAM).

If you are retired, then your insurance cover will be through the General Fund. You will be able to affiliate to via your local CPAM.

If you are planning to run your own business in France there is a separate State controlled insurance scheme for the self-employed called Régime Social des Independants (RSI) .

You will not be able to use the local CPAM if you are self-employed and, therefore, affiliated to the RSI. They only have regional offices, so you many well find yourself having to deal with them on the phone or via the internet.

There are then separate health insurance funds for agricultural workers and other smaller schemes for specialist professions, e.g. civil servants, railway workers, doctors.