1. Structure of Health System
The system of health care in France is known as l'assurance maladie, or Sécu, an abbreviation of sécurité-sociale, although the latter term is often also used to refer more generally to the system of social security in France.
Health care is funded by a dual system of health insurance comprising:
- A State controlled health insurance social security system, the 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, although it is not compulsory to do so.
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.
The main health insurance fund is a General Fund called the Régime Général that covers about 85% of the population working in industry and commerce, as well as the unemployed and those retired and not affiliated to another fund.
Within the Régime Général the Protection Universelle Maladie (PUMA) guarantees permanent health cover for all those who are legally entitled to reside in France, whether in work or inactive.
At a local level the General Fund is administered by a health authority, called the Caisse Primaire d’Assurance Maladie (CPAM).
In the past, if you were planning to run your own business in France there is a separate State controlled insurance scheme for the self-employed called Régime Social des Indépendants (RSI).
Since 2018 the RSI is in the process of being abolished, so that all those affiliated will be transferred to their local CPAM.
There are then separate health insurance funds for agricultural workers and other smaller schemes for specialist professions, e.g. civil servants, railway workers, doctors.
Next: Getting Health Cover
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