6. Family Doctors in France - Médecin Traitant
If you wish to ensure full eligibility to reimbursement of your health costs you are required to register with a doctor as your médecin traitant.
You can still choose not to register a general practitioner, but your medical fees will be higher, and you will receive a lower rate of reimbursement from the social security system.
As this requirement only applies to those 16+ years of age then you are free to take children below this age to any doctor you wish, at any time, without financial penalty.
The process of registering with a doctor takes place when you join the health system through your local Caisse Primaire d’Assurance Maladie (CPAM). They will give you a form to complete, which should be returned via your doctor when you make a visit.
You can also download the Déclaration de choix du médecin traitant, which you can complete and take along to the local doctor of your choice.
It is not unusual for different members of the same family to be registered with separate doctors, e.g. wife registered with female doctor and husband a male doctor.
Children will normally follow their one or both of their parents in the choice of a médecin traitant, but it is not obligatory.
You can later change your doctor, but you need to repeat the same process above. You should also note that a doctor is not obliged to accept all applicants as a patient, or to continue to treat an existing patient.
The most significant aspect of choosing a médecin traitant is that your doctor then becomes the principal route by which you receive specialist medical attention, something that will be commonly understood by those from the UK, but one not easily recognised by the French!
This process is called le parcours de soins.
If you wish to see a specialist, you must be referred by your médecin traitant, failing which you will pay higher specialist fees and receive a lower (30%) level of reimbursement.
You can still go directly to a specialist, but you pay a double financial penalty, although the additional sum involved is unlikely to be prohibitive if you feel it absolutely necessary.
This might not be important for routine consultations, but it can get far more expensive if you need substantial specialist medical care.
There are also certain specialists whom patients can continue to see direct without having to pass through their doctor. These specialists are gynaecologists and ophthalmologists. Those under 26 years of age also have the right of direct access to a psychiatrist.
Patients who have an ongoing illness and need a repeat or continuous course of treatment from a specialist need to only be referred once by their doctor in order receive reimbursement of costs at the standard rate.
Where you are away from home or, in the case of emergencies and you see doctor other than your médecin traitant, the level of reimbursement is not reduced.
Similarly, if your doctor is on holiday or otherwise absent you will be entitled to normal reimbursement from the replacement doctor or other doctor in a group practice, called a cabinet groupé.
In the past, unlike in the UK, doctors have not kept a full medical record of patients they have treated on the principal that patients were free to go wherever they so chose for their medical treatment.
Under government plans it is proposed to that each doctor will hold computerised medical records of their patients (dossier medical personnel), and coordinate any treatment that might be required by specialists.
The record will eventually be contained on your carte vitale although there remain technical problems with this objective.
Where you receive hospital treatment or treatment from a specialist they will have access to this information on your card and will add to it. If a patient refuses to let another doctor or specialist have access to their medical records then it is envisaged they will receive a lower rate of reimbursement for their treatment.
There is great concern in the medical profession about this change, which many consider will be a bureaucratic and IT nightmare. There is also concern it breaches the principal of the right of ‘professional secrecy’ between doctor and patient. It is already clear that the system is only partially in place in some areas, and there are doubts that it will ever be properly implemented due to legal and technical problems!
The plan is to put all records on the system, including outpatient x rays and the results of laboratory tests, but it remains to be seen if full digitalisation of all records can be achieved.
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