What is the Cost of Healthcare in France?
Tuesday 02 December 2008
Whilst most healthcare charges in France are regulated, medical professionals are increasingly imposing charges in excess of the official rates.
Unless you are on an E Form in France, you pay a percentage of your income in social security health contributions.
However, the social security system only reimburses around 70% of the official cost of treatment, leaving the rest to your personal charge, or to be covered by a voluntary 'top-up' health insurance policy, if you have one.
Only those suffering from a major illness receive 100% recovery of costs relating to the treatment of that illness, although only at the official rates. The list of major illnesses that are eligible to receive 100% reimbursement are prescribed by law.
As the French government has held down the official social security system rates, consultants and private hospitals in particular are increasingly imposing charges above these official rates.
These excess charges are called dépassements. Whilst the regulations permit the use of dépassements, they are supposed to be used with ‘tact and discretion’.
As that is a judgement left to the medical professionals themselves, these excess charges are increasingly becoming the norm, particularly for minor operations and treatment.
Expats of retirement age still need to pay those costs not picked up by the social security system, in the same way as does everyone else.
The following is a summary of the main rules governing health charges:
The basic cost of a visit to your French GP is €22, of which the social security system will reimburse €14.40. Most GPs stick to the official tariffs, although even the rates do increase for home visits or out-of-hours consultations, normally reimbursed at the rate of 70%.
The cost of vaccinations varies, but the general level of reimbursement is 65% of the cost. Some vaccinations are reimbursable at the rate of 100% eg tetanus, tuberculosis, rubella. In addition to the cost of the vaccine itself, you will normally have to pay the doctor or nurse, which is reimbursable at the rate of 70%.
The level of reimbursement varies from between 35% to 100%, as denoted by the colour coding on the box. If you seek a branded medicine when a generic alternative is available, then you will only receive reimbursement at the generic rate.
The charges imposed by health consultants for a consultation vary widely, from around €30 to €60. You will find that most charge over the official rate, with the result that the level of reimbursement is less than 70%. The social security system will reimburse €16.10 for a general specialist consultation, which rises to €33.30 for heart specialists. Unless you go through your doctor, the level of reimbursement will be less.
A new law effective from February 2009 requires those consultants who charge in excess of official rates to supply a written estimate to their patient if the treatment is going to exceed €70. Consultants are also obliged to display their tariffs outside their offices, but even where they do so, you need to read the small print for the caveats that apply, particularly relating to the duration or complexity of the treatment.
Some ideas of what these charges look like can be found on the site of Ameli, the French health authority.
The cost of basic dental treatment in France is fairly modest, with most dentists applying the official rates for such treatment. You are reimbursed at the rate of 70% of the official rate. However, if you require more specialist treatment, such as a crown or implant, then the charges rise significantly, and the level of reimbursement often bears little relation to the actual cost.
The official tariff for an eye examination in France is currently €28, for which you will receive reimbursement of €18.60. However, most eye specialists charge more than the official rate, so expect to pay €40-€50 for a consultation. The level of reimbursement for spectacles is negligible.
The level of reimbursement is 80% of the official rate, although patients staying over 24 hours are required to pay a daily charge of €18.
You may also have to pay an additional charge for an individual room, telephone and television.
More often than not, a majority of consultants in hospitals (particularly within 'private' hospitals) will impose dépassements above the official rate, which may amount to several hundred euros for a minor operation, rising to potentially €1000 or more for more complex treatment. You will need to either meet these dépassements from your own pocket, or through a voluntary 'top-up' health insurance policy.
A useful summary of these excess charges was recently provided in the weekly magazine Capital.
What is clear from the analysis is that the use of dépassements is now widespread, and that there is very little uniformity in the rates applied by different hospitals, within or between regions.
Thus, the table shows a charge of around €440 in dépassements for a prostrate operation in the Alpes Maritimes, whilst the same operation in one hospital the Gers will cost you around half that in excess charges.
To have your tonsils removed in one hospital in Paris should cost you an extra €270 in charges, whilst in the Tarn it would be an extra €47.
Some groups obtain 100% reimbursement of the official rate (less the €18 daily charge), notably those with a major illness, pregnant women and low-income households able to obtain free health insurance through the CMU Complémentaire. Consultants are not allowed by the law to impose a dépassement for CMUC patients, although reports are common of such patients being refused treatment if they do not pay the charge.
Voluntary (Top-Up) Health Insurance Policy
If you are concerned about residual health charges in France you will need to meet then you need to consider taking out a voluntary health insurance policy.
The cost of such a policy varies depending on your age, but a couple of 60 years of age might expect to pay circa €100 per month, depending on the level of cover in the policy. Your medical condition is not normally taken into consideration in the calculation of the premium, particularly if you insure through a mutuelle.
However, those costs not picked up by the social security system are not necessarily all picked up by the voluntary insurers, as some minor costs are at the specific charge of the patient. In addition, the level of cover from your voluntary policy will depend on the terms of that policy.
If you are having difficulty in meeting the costs of voluntary insurance, you may be eligible for assistance with the costs of such a policy. (up to €500)
Whilst the level of reimbursement for routine medical treatment does seem to be diminishing, the government confirmed recently that there would be no change to the policy of 100% reimbursement for major illnesses. Whether they can continue to maintain this position is questionable. There have been two official reports this year arguing that reform of this policy is needed, in order to save funds in health service expenditure.
The French government have also recently published a proposal that seeks to crack down on medical professionals who abuse the 'tact and discretion' rule, with local health authorities to be given the power to fine those professionals who abuse the guidelines. However, there is concern amongst the health authorities about the practicalities of enforcing the guidelines, which are only broadly defined. It remains unclear whether the proposed law will ever see the light of day.
You can read more about these and other issues concerning healthcare in France in our comprehensive guide to Health Care in France.
Does Voluntary (Top-Up) Health Insurance Make Sense?