Healthcare in France and the 'Parcours de Soins'
Wednesday 02 September 2015
The parcours de soins is used to rationalise patient health care costs in France, but just how does it operate?
There is no equivalent term for the parcours de soins in the English language, but it can perhaps best be described as a set of protocols that govern patient treatment and reimbursement of their costs.
In essence, what they state is that patients are required to choose a regular doctor for their routine medical consultations, whose responsibility it then is to coordinate their health case, referring them as appropriate to other health professionals.
In short, they provide a gateway into the rest of the health system. That is why the full official term is parcours de soins coordonnés.
The fact that this point should need making at all may seem strange to those from the UK who are used to registration through the GP practice system.
However, in France, until 2005 patients were able to go to any doctor they wished (and many did so if they did not like what they heard), and still obtain full reimbursement of their costs.
It was clearly a system that was financially unsustainable, as a result of which legislation was introduced that obliged all patients to register with a médecin traitant or face a lower level of reimbursement of their costs.
Selecting Your Doctor
The process of selecting your family (or individual) doctor is not difficult.
Once you have chosen whom you wish to use, and they have accepted you as one of their patients, you merely complete the form Déclaration de choix du médecin traitant and hand to your doctor, who will sign it and send it off to your local health authority or 'caisse'. The process can also be undertaken on-line in collaboration with your doctor.
There is not even a requirement that you select a local doctor or even a general practitioner. They can be based anywhere and operating as a specialist. The only requirement is that you make a choice. There is no need for all members of the family to have the same doctor.
You can also later change your doctor, although you will need to complete another round of form filling.
Once you have done so, if the doctor works within in a practice with other doctors, you are able to use any doctor in the practice at no additional charge.
So if your regular doctor is away you are entitled to use his replacement or one of his colleagues.
Similarly, in the event of an emergency or where you are away from home you can use another doctor without financial penalty.
Fabien Pellisier, an English-language health insurance broker in France, points out that a change of family circumstances can sometimes result in the médecin traitant being omitted in error from the health authority database.
"If an individual is listed as a dependant beneficiary on an S1 held by their spouse, when they obtain their own S1 their file is split up and often the CPAM do not transfer the médecin traitant information across, or when someone moves from the RSI regime to CPAM the information is not transferred automatically and it is necessary to complete another form", he says.
In other circumstances, where you have not chosen a médecin traitant you will receive a lower level of reimbursement of your costs as you will not then be following the parcours de soins.
So whereas in normal circumstances you would be reimbursed 70% of the official tariff (less €1 for the participation forfaitaire) where you did not go through your doctor you will receive only 30% of the tariff. Complementary insurers are not permitted to make up any shortfall.
This might not be important for routine consultations, but it can get far more expensive if you need specialist medical care.
Where you need to see a gynaecologist, ophthalmologist, or psychiatrist (for those under 26 years) it is not necessary to be referred by your doctor to obtain full reimbursement. You have the right of direct access in such cases.
Where also you need to see a specialist on a regular basis due to a major illness, once you have been referred by your doctor you can continue to obtain treatment from the specialist without financial penalty. You have no need to go through your doctor for subsequent consultations.
The administration of reimbursements is generally carried out well, although errors do sometimes occur and so you should always check that the correct amount has been credited to your bank account.
This is particularly important where you might not have seen your regular doctor, or you are following a regular course of treatment with a specialist.