10. Hospital Treatment in France
10.1. Types of Hospitals
There are both private and public hospitals in France, but the former (cliniques privées) operate within the public system.
Indeed, there are as many 'private' hospitals (commercial and charitable) as public hospitals.
Such is the overlap between private and public that many public hospitals offer certain privately run services, eg MRI scans. This occurs as it is frequently the only way to ensure that consultants are willing to work in public hospitals.
That part of the health system that is truly 'private' (non-conventionée) is very small.
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).
If you admitted as an in-patient to hospital, or as an out-patient for a consultation or tests, you will need to produce:
Your health insurance card (your carte vitale), or;
The notice (attestation) you will have received confirming your entitlement to health care;
Your voluntary insurance policy if you hold one;
Your passport or identity card.
If you are in possession of 'S' form certification, such as an S1, you also use your carte vitale or attestation.
In all cases, the eligible costs of treatment will be met through your local health authority - your Caisse Primaire d'Assurance Maladie (CPAM).
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.
If you do not have health cover, 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.
In such cases, 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.
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.
10.4. Hospital Charging Policies
There is no uniform set of charges in French hospitals.
Public hospitals will charge the official rate, but the charging policies of the many private clinics varies.
That is to say, some private clinics 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, in many public hospitals consultants have been granted the right to charge more than the official rates. These extra charges are called dépassements d’honoraires, and they are becoming very common.
As a general rule, most hospitals and clinics recover the eligible fees directly from the social security system and the voluntary insurers, so at the end of your stay you are only faced with having to pay non-eligible costs.
This process of recovery direct from the insurance system is called le tiers de paiement.
Only where you use a private clinic non-conventionée would you be required to pay your costs directly to the hospital and then claim reimbursement (80% of official tariffs) from the social security system. Your voluntary insurer may also pay some or all of those costs not reimbursed by the State.
10.5. Reimbursement Levels
The system of reimbursement is becoming ever more complex as the government tries to find ways of pushing more of the costs onto the patient or insurers, and consultants impose extra charges.
It is, therefore, only possible in this guide to give an overview of reimbursement levels, as there are so many variables it is unwise to generalise.
The basic rule is that hospital treatment costs are reimbursable through the social security system at rate of 80% of official rates.
However, here are a number of ineligible costs that you must pay, or which may be paid by your voluntary insurer.
First, the social security system does not cover the cost of a private room (unless required for medical reasons), telephone calls, television etc.
Second, neither does it reimburse those charges in excess of the official rates, such as the additional fees (dépassement d'honoraires) that some consultants charge.
There are also two fixed sums that are payable by the patient, although exemptions apply.
The first one is that of the forfait journalier hospitalier, a daily charge of €20 towards the cost of your stay - bed, meals, heating etc, provided you are admitted for at least 24 hours.
The second is the participation forfaitaire, a charge of €24 payable if you receive medical treatment costing more than €120 (2020) at the official rate. The charge is applied for any single medical treatment or for multiple medical acts during the same consultation, where the total charge is more than €120.
If you are hospitalised, the charge is applied only once for any single admission.
If you have a voluntary health insurance policy or private policy, these costs may be covered by that policy, depending on the terms of your policy.
There are a number of important exonerations from the two forfait charges for certain types of treatment and for certain groups of people, whose costs will be reimbursed at the rate of 100%.
Those exonerations by treatment are:
X rays or scans; Certain laboratory tests; Emergency transport to hospital; Long term hospital care (over 31 days).
Those groups who receive exoneration are:
Long term/major illness (ALD); Treatment for sterility; Pregnant women (last three months); Mothers of newly born children (first 30 days); Recipients of invalidity benefits/pensions; Suffering from work related illness/accident; Recipients of complémentaire santé solidaire sans participation financière. Residents of Alsace-Moselle
If you are admitted to hospital on an emergency basis the transport costs are met by the health system.
Otherwise, if it is necessary for you to be provided with transport to receive your medical treatment, the cost is reimbursable, provided it is authorised by your doctor or specialist.
The basic rate of reimbursement for transport (personal vehicle, taxi, public transport) is 65% under the national insurance scheme, with the balance reimbursable from your voluntary insurance policy if you have one.
You can read more at Transport Costs and Health Treatment in France
It is also possible to be hospitalised at home (hospitalisation à domicile), possibly after a period in hospital, or directly through your GP or consultant, when you will receive reimbursement of costs at the same level as if you were an in-patient.
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