7. Your Family Doctor in France
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 with 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, 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). The staff here 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.
However, doctors can choose whether or not to accept a patient, and with many GPs under pressure, there is no guarantee that you will be able to obtain the GP of your choice.
In many areas of France it is difficult to find a GP who is willing to accept new patients, a problem we set out in our Newsletter article GP Shortages in France.
In response to the shortage, the authorities (including local councils) are developing generic health centres, called Maisons de Santé Pluri-professionnelles (MSP), where several doctors, nurses and other medical staff are located.
It is not unusual for different members of the same family to be registered with separate doctors, e.g. the wife registered with female doctor and the husband with 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 process described above. As we state, a doctor is not obliged to accept all applicants as a patient, or to continue to treat an existing patient.
7.2. Le Parcours de Soins
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.
This might not be important for routine consultations, but it can get expensive if you need substantial specialist medical care.
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 to be absolutely necessary.
If you have tried unsuccessfully to register with a doctor, it may still be possible for you to obtain reimbursement of charges in the normal way, although you will need to prove to your local health authority (CPAM) that you have tried and failed to find a doctor.
There are also certain specialists whom patients can continue to see directly without having to go via 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 may have to 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.
Until you obtain your health insurance card (carte vitale) each time you have a consultation with your doctor you will be given a receipt (feuille de soins) by the doctor when you pay for medical services.
The doctor will also issue you with a prescription that you should take to the chemist to obtain your medicines.
You will need to take both the feuille, the prescription and your 'attestation' (or European Health Insurance Card details) to your local CPAM for reimbursement. The feuille de soins will need to be signed by you.
The charge for a consultation with a GP is on the same basis as is used for all health reimbursements, based on three factors:
the regulated fee for the charge
a rate of reimbursement
- the surcharge (participation forfaitaire)
Thus, if you see your doctor the standard charge (fee) for a consultation is €25 (2021). There are slightly higher rates for children younger than six years (€30).
You will receive reimbursement through the social security system at the standard rate of 70%, less the €1 participation forfaitaire.
So, in the case of a consultation with your GP this reimbursement works out at €16.50, less the €1 surcharge directly payable by you, ie, €15.50.
This leaves €8.50 to be funded by you, of which €7.50 may be reimbursed by your voluntary insurance policy (if you have one).
The €1 surcharge is not reimbursable by either the statutory or voluntary system.
Thus, in detail, for a consultation at €25:
Social Security- €16.50 (€25 x 70%) - €1 Complementary Insurer/Patient - €7.50 (€25 x 30%) Patient Charge - €1
If you need to receive a home visit from your doctor, then a higher charge will apply. The social security system will reimburse 70% of this charge, less the €1 surcharge.
In addition, in certain cases a higher charge may apply for consultations that are deemed 'complex' or 'very complex', which are stipulated in a list issued by the government. The fee for such consultations ranges from €46 to €76,70 (2019). The same percentage level of reimbursement will apply to such consultations, ie, 70% and 30%.
You will only receive the full reimbursement for a home visit if the GP considereds that by virtue of your age or medical condition, a home visit is warranted.
The fee charged by the médicien traitant excludes the cost of prescriptions, laboratory tests and other medical treatment that may be needed.
The basic fee covers only the consultation. You will need to pay and receive separate reimbursement for all prescriptions etc.
The level of reimbursement for each medicine will be shown on the receipt printed on the back of the prescription and this can vary, as we state elsewhere in this guide.
7.4. Medical Records
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 current government plans it is proposed that each doctor will hold computerised medical records of their patients ( Dossier Medical Personnel or DMP), 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, 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.
You can read more about the DMP in an article from our Newsletter at Health Record System Goes On-line.
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