Getting Healthcare in Paris
For many expatriates, affordable and quality healthcare is essential when it comes to relocating for a work assignment. Concerns such as the ratio of doctors to patients, waiting times, the number of private and public hospitals available, the use of public and private health insurance options, and the quality of medical care are non-negotiables. For this reason, the French healthcare system is acknowledged as one of the best in the world. For a significant number of expats, the high standard of healthcare in Paris is one good reason for moving to Paris, and maybe even consider living in France in the near future. Here's what you need to know about getting healthcare in Paris.
Healthcare in France: Public and Private Healthcare in Paris
The public healthcare system in France went through several reforms in 2004, which included the introduction of the Carte Vitale smart card system. In 2008, the World Health Organization named the French healthcare system as the best in the world when it comes to availability and organization of healthcare providers.
As one of the countries with universal healthcare coverage, France offers a combination of public and private medical services for all its residents regardless of age, income or status, including foreigners. A majority of French healthcare costs are covered by the government through a public health insurance scheme that mandates residents in France to register with a French health insurer and with a local attending doctor, such as a general practitioner (GP). General practitioners serve as the first point of contact in primary care for medical treatment and specialist referrals.
Paris has a big network of private hospitals and state-funded hospitals, and specialist clinics that are well equipped with facilities and state-of-the-art technology. Public hospitals in Paris are grouped under the Assistance Publique Hôpitaux Paris (AP-HP), which includes hospital groups, general, university-affiliated and specialist hospitals.
Private clinics are also available in Paris but may charge higher fees for services. If you require a specialist's treatment and decide to bypass your local GP, you're likely to receive a lower reimbursement and may have to pay higher out-of-pocket fees.
Medication, including over-the-counter drugs, can only be obtained in pharmacies, which are plentiful in Paris. Pharmacies are identified by the illuminated cross sign, which is usually red or green. Many are open Monday to Saturday, from 9 am to 6 pm, and there are late-night pharmacies open.
For a list of healthcare facilities in Paris such as hospitals, emergency services, and pharmacies, please visit the Health directory of the Paris City Hall. In the event of an emergency during late hours, expats can call 116 117 to find the nearest emergency doctor or dial 112 on their mobile phones. Translators are available to help you find an English-speaking doctor or information for the nearest hospital.
The European Health Insurance Card
Nationals who hold a European Health Insurance Card (EHIC) issued by an EU member state may use it to obtain healthcare services in France. However, they have to be a tourist or on a temporary visit - not a resident of France or working in the country - in order to use the card. Unlike legal residents in France, EHIC holders are not required to register with a local GP to visit a specialist.
How Does the French Healthcare System Work?
The French healthcare system obtains partial funding through mandatory social security contributions paid via salary deductions. Through this, the government is able to reimburse up to 70 percent of doctors' fees and up to 80 percent of hospital costs. The remaining balance is covered by a voluntary health insurance system which may take the form of private health insurance plans.
In 2016, employee contributions comprised 8 percent of their monthly salary, with employers paying approximately 13 percent for health costs. In 2018, the 0.75 percent employee contribution for health insurance was removed as well as the 2.4 percent contribution for unemployment. Employer contributions for health costs - which include maternity, disability, and death - and unemployment remains at 13 percent each month.
In 2016, the French government introduced a new universal healthcare system for foreigners called Protection Universelle Maladie (PUMA), which replaced the previous Couverture Maladie Universelle (CMU) system.
Unlike CMU, PUMA extends healthcare coverage to all individuals working or residing in France for at least three months or longer. For those who are not employed, such as spouses of expatriates in France, they are also entitled to healthcare as long as they're living in France on a steady basis for at least three months. The new system reimburses any healthcare costs incurred by the insured persons and their minor dependents and provides daily sickness benefits for those who are temporarily unable to work.
Eligible expats under PUMA must register for French healthcare with a local GP and the appropriate French health insurance authority through their local CPAM (Caisse Primaire Assurance Maladie) office via the Ameli website at https://www.ameli.fr. Employers of expatriates may do the preliminary registration for French social security on their behalf, after which, they can register with the French healthcare system themselves.
You need to show identification such as your passport or national ID, your residence permit, and marriage or birth certificates if you have your spouse and children with you. Proof of address and income and a declaration from your chosen local GP must be given to your local health insurance provider before you can avail of French healthcare.
Reimbursements, Fees, and Charges
Remember that you'll only get your reimbursement as long as you are officially referred to by your GP. Under PUMA, doctors and select medical personnel are paid directly by the government or health insurance company, instead of having patients pay upfront and claim reimbursement afterward. As the government reimburses only a certain percentage of healthcare costs, the patient pays the remaining balance or through a supplementary private health insurance company.
If you have a serious or chronic illness such as cancer, AIDS or diabetes, no co-payment is required and 100 percent of healthcare costs are covered. However, it's still advisable to have a comprehensive international health insurance plan to ensure that any contingency is adequately covered.
There are small mandatory co-payment fees such as a EUR 1 charge per GP visit, EUR 0.50 for each prescribed medicine, both of which are limited to EUR 50 annually; and a fee of EUR 16 to EUR 18 per day for hospital stays that mostly covers food and other small amenities.
Most French residents avail of complementary health insurance helps them pay their personal contribution. This type of private health insurance may be subsidized by employers of those working in France and offers basic packages enough for hospital costs and medication.
The Carte Vitale
The Carte Vitale is a health insurance card issued in France to anyone aged 16 and older. The card includes a photo and is embedded with a chip containing your name, address, social security details and any relevant info for payment exemptions. No medical information is included in the chip.
For expats and their dependents must register with the French healthcare system to get their respective cards. However, it may take some time to get the card so best to follow up on the process and make sure all the necessary documents are provided to obtain one.
If you don't get your Carte Vitale quickly and require a health service, ask for a social security certificate as proof that you have access to French healthcare. You may have to pay upfront for the treatment and with it a Feuille de soins that serves as an invoice and states the treatment and any medication you received. You need to send your Feuille de soins to your local health insurance authority, the Caisse Primaire d'Assurance Maladie, to get your reimbursement.
Bring your Carte Vitale whenever you have scheduled doctor visits, hospital or specialist appointments, or to a pharmacy. Doctors and pharmacists use a card reader to swipe the Carte Vitale. This enables you to get your reimbursement from the health insurance fund instead of having to submit a Feuille de soins. If you have an international health insurance plan, check that they're linked to the French healthcare system to ensure that any fees covered by your plan are reimbursed.