If quality healthcare is a priority for your retirement, you can’t choose a better destination than France. According to the World Health Organization’s ranking of the most efficient healthcare systems, France delivers the highest quality of healthcare of any country. From its high ratio of doctors to patients to the length of wait times, France consistently delivers strong results.
Expats love the system, along with life in France in general. An impressive 78 percent report being satisfied with life in France. In fact, 40 percent of them have no plans of ever leaving. Of course, that doesn’t mean there isn’t a steep learning curve. If you hope to join this group of happy adventurers living overseas, here are the basics that you need to know about navigating the French healthcare system.
1. France Has Universal Healthcare
The French healthcare system is premised on universal healthcare. The system is known as the Protection Maladie Universelle (PUMA), and it was recently revamped in 2016 to be more comprehensive and affordable. This overhaul brought some much-needed change.
The previous system, known as Couverture Maladie Universelle (CMU) was also premised on universal healthcare, but it was less all-encompassing. Patient access and costs were tied to employment status. Today, a CMU-era program to provide free insurance to those with low income has been rolled into the PUMA system and other reforms have taken place so that an estimated 96 percent of all French residents are covered by the public healthcare system.
2. There’s A Focus On Preventative Care
Preventative healthcare is highly valued in France. All patients are entitled to a comprehensive, preventative physical every five years. All hospitals are state-owned and regulated to be not-for-profit, so there are few barriers, if any, to getting screening tests and seeing specialists.
Alternative healthcare methodologies are respected, and if a patient wants to see an alternative practitioner for weight loss or smoking cessation help, the healthcare system supports it.
3. Costs Are Extremely Low
The French healthcare system is funded through government sources and salary deductions. All employees pay into the system. A salary deduction of approximately 8 percent is designated to help pay for healthcare costs.
In general, approximately 70 percent of healthcare costs, including general practitioners, hospitals, dentists, and pharmaceutical costs, are covered by the government. Patients pay the remaining 30 percent. In practical terms, patients can expect to pay about 10 euros for an emergency room visit and about 7 euros for a typical medical appointment. If you have to stay in the hospital for long-term treatment, it costs about 18 Euros a day. The rates that doctors and hospitals can charge are regulated by the state. Senior citizens and those with chronic conditions have 100 percent of their medical costs covered.
4. Expats Are Included In Public Care
All legal residents in France are eligible for public healthcare coverage, regardless of employment status. This is one of the biggest changes between the CMU system and the new PUMA system. Previously, health coverage was tied to certain employment conditions — and a five-year residency period.
So what exactly is legal residency? First, you must be living in France — legally — for three months. You must be living in France in a “stable and regular” manner. You must also be living in France for more than six months of the year. This means that short-term tourists aren’t eligible. Nor are people who spend the winter months in France but live elsewhere for the rest of the year. And as for “stable and regular,” well, that’s open to interpretation, but you should be able to point to evidence that you intend to make your life in France. Having a job or volunteer program points to living in the country in a stable and regular manner, as does renting an apartment and taking care of all other logistics that come with moving to a new country.
5. Signing Up For Healthcare Coverage Is A Bureaucratic Adventure
If there’s one thing that every country shares, it’s a love of bureaucracy. France is no exception! As such, you can expect a fair bit of paperwork on your journey to join the French healthcare system.
The first step for people born outside France is to register for a social security number at the local CPAM (Caisse Primaire d’Assurance Maladie). To do so, you will have to bring your passport, visa (if applicable), birth certificate, lease or rental agreement, and proof of income. If you’re retired and no longer have employment income, you’ll have to demonstrate that you have your own source of income (for example, a pension or other savings). You’ll also have to prove that you’ve been in France and living as an expat for at least three months. Copies of utility bills and other pieces of mail like credit card statements are considered acceptable documentation.
If your documentation isn’t written in French, you’ll need to get a notarized translation. If you’re not fluent in French, it’s a good idea to have a bilingual friend to help you out.
Once you’re at the CPAM office, you can also register for your national health card, known as the Carte Vitale. You can also receive advice on how to register for a local doctor in your neighborhood. Carrying your Carte Vitale with you to any French healthcare appointment is essential. This little card allows you to be reimbursed directly from the health insurance fund for the consultation or treatment within a week, meaning you don’t need to pay upfront aside from your small copay.
6. You Can’t Just Visit Any Doctor
Visiting a GP — with your Carte Vitale in Hand — is your first step when you need help. You are free to choose any doctor you prefer but you must register with them and declare them your primary physician in order to claim full coverage for your visits.
You can transfer to another doctor if you’re unhappy but — surprise! — there’s paperwork involved to do that. Checking in with other expats, be it in person or via an online group, is a good way to get a lead on local doctors who speak English and are familiar with the expat community.
7. You Also Can’t Just Visit Any Specialist
In some countries, if you feel you need a dermatologist or cardiologist, you can just call up the office and make an appointment. This isn’t the case in France. You need a physician’s referral to see a specialist. Otherwise, you have to pay a larger copay (and specialists might refuse to see you altogether without a GP’s referral.) This system does come with benefits. Your GP can make an initial assessment and provide some treatment options or preliminary testing while you’re awaiting the specialist. They can also make sure you’re on the right track. Not all patients can easily distinguish whether they need to see a sports doctor or an orthopedic surgeon, for instance.
However, there are some exceptions to this rule. Patients don’t need a referral to see a gynecologist, a pediatrician, or an ophthalmologist. And those under 26 don’t need a referral to see a psychiatrist.
8. You Can Mix Public And Private Care
France may have an excellent healthcare system, but it’s not without its challenges. Wait times for specialist referrals and hospital services are among the common complaints. As such, many patients carry private health insurance to augment their public care.
In general, patients in a public clinic or hospital can expect quicker services, a greater degree of privacy, and more comfortable surroundings. Private health insurance can also cover the cost of services not included in the public system. These include consultations with chiropractors, physiotherapists, and massage therapists. Private insurance also reimburses patients for the 30 percent copay that they typically pay at the hospital and medical appointments. While these out-of-pocket costs are quite small, it’s nice to get them reimbursed if you can.
Editor’s Note: You can find the WHO’s ranking of the most efficient healthcare systems, referenced in the first paragraph of this article, here (opens as PDF).
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