Sunday, 26 September 2010


The French healthcare system is reputedly among the best in the world, and France is frequently quoted as the country that tops the World Health Organisation’s ranking of health care systems. But the last such table created by the WHO was released in 2000, which is now ten years ago and there will not be another one due to the complexity of actually creating the rankings. So is the idea of France being the world’s best country for healthcare now little more than an outmoded notion?

 I have always been happy with the medical care I have received in France. Even GPs are extremely attentive and thorough and there are abundant numbers of specialists available for consultation. Everybody in employment pays social security contributions, which reimburses part of the money that you pay towards the costs of appointments and prescriptions and most people either opt for a company private medical insurance policy or pay via a separate body as well. The private medical insurance is supposed to reimburse what the social security doesn’t, so that even though you pay upfront for services, you get 90-100% of it back.

This all sounds pretty sweet. However, there is a bitter taste in your mouth afterwards. The amount of reimbursement you receive, even though theoretically it is close to the whole amount, depends on a number of factors, including your age, whether or not you are in employment, whether or not you have children and others. This therefore means that you can end up out of pocket – hence the inward groan when I realise that I have to go to the doctor or dentist. Being an unmarried, childless, 24-year-old woman who works, I do not always receive the ideal level of reimbursement.

One concept of French healthcare that is foreign to any Brit is the notion of paying for contraception. That’s €100 a year for the contraceptive pill gone. Unless you are comfortable being totally reliant on condoms, all options are expensive: with the medical appointment and the smear test that getting the pill also entailed for me, the bill was closer to €200. None of this was reimbursed due to the French state not reimbursing contraception costs at all (would they prefer me to cost the state more by having a baby, I wonder?) and due to the fact that gynaecologists are in short supply due to increasing numbers of – often fraudulent - lawsuits against them. You therefore have to see whichever gynaecologist has room for you on their books (many do not have room for new clients) and invariably the ones who do have room on their books are “secteur 2”: French for “free to charge more”. The “secteur 2” doctors are effectively untouchable and if you see one you will not be reimbursed for your appointment (this again is something you have no choice about – GPs prefer you to see a gynaecologist, and there is no such thing as just dropping off the paper for a repeat prescription in France).

Sounds complicated? You bet it is. And this is all without mentioning the rigmarole that you go through to sign up with the French social security service. Your employer should do all of the leg work, but the operative word here is SHOULD (not all employers are this reliable). The result is therefore often endless frustrating phone calls and trips to the social security office. I perhaps stupidly assumed that my French fiancĂ© would know what procedure I should follow, but being signed up to the system from birth, which provides you with the sacred green card that is swiped every time you have an appointment or purchase a prescription, he wasn’t too aware of all the red bits of paper I had to fill out until my social security card arrived. I therefore unfortunately missed a crucial detail: in order to receive the reimbursement, you had to stick the barcode sticker from your prescription product onto the paper. Sometimes the pharmacist did this for you, but not all of them were this nice, and I didn’t notice when I needed to do it. It consequently wasn’t until the social security service wrote to notify me that my forms were incomplete without the stickers that I realised how much money I had lost (by then, of course, the prescription boxes, with their holy stickers, had long hit the recycling bin).

You can imagine, then, the “Hallelujah” moment that I had when ten months after my arrival in France my green card finally arrived through the door. It makes things a million times easier, even if I am not always reimbursed the full 90%-100%. I just hope that I never become blasĂ© about what I went through in order to get it.

As for whether or not the French healthcare system is really the best in the world…it may well be. The access to specialists is second to none, with there being none of this waiting for weeks for referrals. But nevertheless, in comparison the fixed price of prescriptions and the sheer simplicity of just being able to walk in and have a free appointment with an NHS doctor are certainly not things to be sniffed at. 

Bianca Summons

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