How does the French healthcare system work?

The French healthcare system has a reputation for excellence and is a big attraction when it comes to moving to France. Here’s how it works and what it covers – and how Brexit might affect access to it

The French healthcare system is predominantly funded by welfare taxes, however you are also expected to pay a certain percentage of any healthcare services you use – the theory being that personal contribution reinforces the socialist ideal of shared responsibility. The percentage varies depending on the type of treatment, though for most necessary healthcare it remains a relatively small percentage.

So how does it work?

In France, anyone who works in the country (therefore paying the equivalent of National Insurance contributions) and anyone legally living in France on a permanent or semi-permanent basis (even if not in work) is, de facto, eligible for state-assisted healthcare. Access was simplified at the beginning of 2016 with the introduction of PUMA (la protection maladie universelle) which replaced the former CMU (couverture maladie universelle) – the principal change was to simplify administrative procedures.

The state healthcare system operates via what is known as the carte vitale which effectively acts as a person’s identity card within the French welfare state, including the health sector. So, obtaining your carte vitale from the local CPAM, Caisse Primaire d’Assurance Maladie, is probably the first thing you should seek to do when moving to live in France on a permanent basis. Thereafter, the state percentage of any health costs you incur are automatically refunded via the carte vitale system.

To cover the percentage of healthcare costs not covered by the state, you can opt for an additional private health insurance, known as a mutuelle. Costs are significantly lower than private health insurance in the UK, and most French people have a mutuelle. Since January 2016, it is compulsory for private companies to provide employees with a company private health insurance policy, known as a mutuelle collective, to which the company must contribute a minimum 50% of the mutuelle’s cost. (This new law does not apply to public sector organisations.)

Ophthalmologists

As with all specialist healthcare treatments, it works out cheaper to get a referral from your doctor. Without a referral, the share of costs subsidised by the state health system (in most cases 70%) might not be refunded. And, as the private health insurance repayments (paid by your mutuelle) are usually triggered via the state system, you risk losing out on these refunds too. Check that the practitioner is conventionné (secteur 1), that is, signed up to the fixed tariffs agreed by the French state. If they are non-conventionné (secteur 2), this means they are free to set their own prices, however you will only be refunded by the state to the level of the conventional fixed tariff. Some mutuelles will pay all or part of costs above this threshold (known as dépassements), but if not it will come directly out of your pocket.

Most ophthalmologists are signed up to the fixed tariff convention. The fixed price for a basic consultation with an ophtalmologue conventionné is €28 of which 70% is reimbursed by the state. Again, prices for practitioners operating outside the convention (honoraires libres) can be higher, and while this may not make much difference for a basic visit, it could be more of a factor if you require treatment subsequent to your initial consultation.

Dentists

It isn’t difficult to find a dentist in France, however you may have to wait a couple of months for an appointment. Again, check practitioners are conventionné, and if possible seek a recommendation from someone you know. Most dentists in France carry out the cleaning part of the check-up themselves, as well as any dentistry needed. It is also common for them to take an x-ray of your teeth at the appointment. Conventional tariffs (as set by the authorities) for standard dental work start at €23 for a basic consultation.

Orthodontists

Make sure you have good cover included in your insurance for orthodontics as prices can be high, as much as €1,000 per half year, of which just €193 is reimbursed by the French welfare system (known colloquially as the sécu). The sécu will pay these costs for up to six semesters of orthodontic intervention up until the age of 16. If your child needs all six semesters, you risk paying out €6,000, and recuperating just €1,160 from the state. Mutuelle repayments are based on a percentage of the state contribution, with 100% equalling the full amount of that contribution (so, in this case €193), which means you may need to choose up to 400% repayment for orthodontics in your mutuelle to recuperate the lion’s share of what you pay out.

What happens after Brexit?

In September, the UK government published an update regarding healthcare arrangements after Brexit. According to the gov.uk website, if a Brexit deal is agreed your current rights on access to healthcare in France will remain the same until the end of the implementation period, as long as you remain resident in France. If there is no deal, your access to healthcare is likely to change. Following new legislation, the French government has indicated that if there is no deal, UK pension holders with an S1 form (the certificate of entitlement to healthcare in another EEA country, provided via the social security authority in your home country) that are resident in France before Brexit will continue to be entitled to healthcare for up to two years on equal terms to local healthcare users, while a longer term agreement is negotiated. The French government has also indicated that EHIC cards will no longer be valid if there is no deal.