Healthcare in France

Introduction

France has the largest land area in Europe, housing 64 million people as of January 2007. This ranked France as the 23rd most populous country in the world. The estimated birth rate as of 2000 was 12.27 births for every 1,000 of the population and infant mortality is 4.51 deaths per 1,000, which is relatively lower than other developed countries. Life expectancy is one of the highest among OECD countries, estimated at 74.85 years for males and 82.89 years for females. It was the highest achieved life expectancy rate in the world for those born in the year 2000.

In addition to the natural population growth, there are a number of migrants who come to France on an annual basis. In 2004, there were more than 140,000 migrants, the majority of which came from Africa (65%) and Europe (10%). In 2006 the total migrant population was approximately 4.9 million, totalling 8% of France’s population.

About 65% of the population is between the age of 15 and 65. In this age range a person is considered at the peak of their productivity. This productivity statistic ranks France as the highest among the G7 countries at 47.7 US dollars. Despite this, only 69% (approximately) of those within the age range of 15 to 65 are actually working. This ranks France ranks significantly below the United States, Japan, United Kingdom, and Germany.

French healthcare at a glance

French healthcare is widely regarded as the best in the world. It was ranked 1st by the World Health Organisation in 2000. Healthcare is provided free (or highly subsidised) by the government. France’s budget allocation for healthcare is about 9.8% of GNP. This places a large burden on the French government, resulting in approximately €11billion in budget deficit at the end of 2004. This figure is estimated to increase to €70billion by the end of 2020.

Management of France’s healthcare system is done through the social security system. Healthcare funds are predominately derived from the income of France’s working population. It is estimated that almost 21% of an employee’s compensation, including employer contribution, is remitted to the government. Of this amount, 12.5% is contributed by the employer and 0.75% by the employee; 7.5% in social security tax is also collected from the employee. This accounts for 60% of the social security fund. Other fund sources are indirect taxes from alcohol and tobacco.

Healthcare is highly socialized. It does not discriminate by income levels; everyone is entitled to an equal level and quality of service in both public and private institutions. There are also no waiting lists for surgical procedures.  Anyone can consult any health practitioner he/she wishes to, in any public or private hospital or clinic. The poorest of the population and those suffering from long term illnesses are fully covered by the government.

France is implementing a standard tariff scheme for all services. Medical practitioners are categorized as either conventioné or non-conventioné. Conventioné practitioners adhere to the standard tariff rate while the non-conventioné can charge the rate they like. However, almost all health practitioners (97%) are conventioné, even the private ones (for competitive reasons).

The usual rates for professional consulting are €21 for a médicin traitant, €24 for children aged between two and six years old, and €25 for children under 2 years of age.

Services and prescribed medicines are not fully reimbursed. This can be based on the income level of the individual or a family. The typical reimbursement rates are 95% for a major surgery, 80% for a minor surgery, 95-100% for pregnancy and childbirth, 65% for prescribed medicine with blue labels and 35% for white labels, 70% for x-rays, and 75-80% for GP/specialist consultations and treatment. Thus, around 80% of the French population still avail of supplemental health insurance to cover the difference in the actual cost and the reimbursed amount. Again, this costs the employee about 2.5% of their salary.

Considerations for expatriates and visitors

Visitors are generally not required to take any vaccinations. However, although the risk is low, there are incidences of rabies and bird flu. Therefore, proper precautions are advised. There is also a high risk of tick-borne encephalitis when going to forested areas and as a result, vaccinations may be required.
Emergency care is provided free, particularly for European visitors with valid European Health Insurance Cards. However, visitors to France are advised to have full travel insurance.

EU expatriates with an E106 form will be able to avail of the cash reimbursement benefit. However, this is only valid for two years and strictly adheres to the fiscal year schedule of January to January. For example, if the expatriate arrived in France in July, then only 6 months will remain for that fiscal year to utilize their E106.
Once the E106 expires and the expatriate is not yet qualified to avail of the E121m, they will have to apply to the CMU (Couverture Maladie Universelle). This will entitle them to the carte vitale or the “green card” to officially make them a resident of France. This will enable them to avail of any standard medical reimbursements. Similar to the French, the EU national may avail of “top up” insurance policies.

There has also been a recent announcement from the French authorities that EU residents in France who are not working, but are not yet of the retirement age, will be considered as economically inactive. This means that their green card will be cancelled along with their health cover. These changes do not affect those that are in the retirement age and have the E121 form.