Healthcare in France

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Healthcare is one of the attractive features of my life in France. Honestly, I could never imagine running my own business or being an entrepreneur in the U.S. without having a safety net like it if anything ever were to happen to me. Having healthcare means I can be creative, I can take risks, I’m free to run my own business and do the work I do and am best at (which is anything but the typical 9-5 job). If anything major happened to me, I know I’d be supported by the national rather than racking up heathcare bills that would be even more hazardous to my health (back when I worked in the States and had good insurance, the health system still caused me a lot of anxiety).

So, here is my American perspective of navigating French healthcare. I’ve already survived bureaucracy, and thankfully healthcare rarely causes me much stress – except when my American-ways get in the way. I hope this can also serve as guide to what to expect at the doctor or Emergency Room in France should you ever find yourself here. Even if you don’t speak the language, don’t worry, you won’t be turned away.

Disclaimer: this is the Cliff Notes version. Don’t take everything at face value. These are my experiences, and I invite others to share their experiences navigating healthcare in France in the comments.

Let’s visit a few scenarios:

CHEZ LE MEDECIN
I’m usually able to make an appointment within a week or two. If I’m really sick, I can almost always make an appointment for that day if doctor can fit me in. All my doctors’ offices are inside typical Parisian apartment buildings. I feel more like I’m visiting a home rather some sterile, soul less room with ugly furniture. There is almost never a receptionist (except at my gynecologist’s practice where a few doctors each have their own rooms – I also pay more at this doctor, as you’ll see below). That means that most of the time it’s the doctors themselves answering the phone and taking appointments, which can get admittedly get slightly frustrating when you’re in the middle of an appointment when you really don’t feel well. The biggest difference between France and the U.S. is that you won’t find gowns (paper or cloth) at the doctor’s office. Modesty isn’t really part of the culture; think of it more as something that makes your visit more affordable!

pretavoyager-doctorfrTo get to my regular doctor I go through two sets of beautiful big wood doors, pass through this garden courtyard, and then head upstairs. The office itself is pretty boring, and not nearly as photogenic as this. I will note that I think my doctor thinks I get too much exercise!

I typically pay 25€ for visits to my regular doctor (médecin traitant). Part of that visit is covered by Social Security (Sécurité Sociale) into which I pay, I’m reimbursed for some – or all – of the cost of my visit. Many people in France also have a “mutuelle” which is additional insurance. Compared to the U.S. even paying full price is so affordable that I didn’t feel it was necessary to have the additional insurance.

However I recently had a meeting with my banker, and now I pay 21€/month towards a mutuelle. He assured me it’s good to have a mutuelle should I ever need an extended hospital stay. I’d definitely have a mutuelle if I worked as a salarié (full time employee), but as a freelancer it’s extra. I also regularly pay a lot into Harmonie Mutuelle, which despite the name, is not at all a mutuelle, but is the group that manages my health care [RSI] under my particular business status. So no, health care in France is not free, but it is affordable, and helps take care of everyone.

pretavoyager-FrenchgynoThe waiting room of my gynecologist is WAY nicer than most doctors’s waiting rooms. This doctor is more expensive (90€/visit), but she has a different status as a doctor, and I’ve kept going even after my amazing student insurance ended. Still, it’s nice to be in a “home” setting for a check-up. I always joke I could live here!

Another slightly strange thing for Americans when it comes to going to the doctor in France is that most of the time lab tests don’t happen at the doctor’s office. Instead, you go to a “Laboratoire” which specializes in different tests. The doctor will give you an ordonnance (prescription) for the tests you need. They don’t cost very much and depending on how long it takes to process the results, they will soon be posted online, as well as sent to your doctor. I’m fairly certain I’ve even had to walk down the street with my pap smear in hand in order to drop it off at a lab. Similarly, because doctor’s offices are typically in independent apartment buildings, it means there is not a pharmacy attached. If you ever need a shot, you’ll need to pick it up at the pharmacy and take it back to the doctor to administer.

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Good dental coverage is not very common in France. I pay dental out of pocket (~60€). I like going to my dentist just because he has the coolest waiting room ever!

LA PHARMACIE
I’ve learned the hard way over the years that I could have just gone to the pharmacy 90% of the time and they could have given me just the medicine I needed. (There are also a few 24 hour, 7/7 pharmacies around the city too). In general medicines are far less expensive in France than in the U.S. However, when you feel awful and are upset, don’t expect a lot of compassion from the people behind the counter most of the time (I have had some great [warm] pharmacists help me too!).

IN CASE OF EMERGENCY
In France les pompiers (firemen) are the first responders – yes, they do more than hosting awesome dance parties for 14 juillet! Earlier this year I was walking with a friend visiting when her knee gave out unexpectedly. She couldn’t move so the lovely gentlemen behind us called the pompiers and waited with us until they arrived. I of course went along. I was relieved to add another hospital adventure to my list of experiences that was not my own. You call 112 in case of emergency in France. I don’t know what her medical bill ended up being, but I think she was fortunate it happened in France rather than in the US!

pretavoyager-parisambulance 600My view from inside the ambulance when the pompiers picked us up. Due to the nature of the case they ended up taking us to a hospital on the other side of the city. 

SOS MEDECINS
When I feel really awful, so much so that I don’t have the energy to leave the apartment (particularly back when I lived in a 7th floor walkup), it’s nice to have the option to call SOS Médecins. It’s more expensive (~70€/visit) than going to a normal doctor, but it also means the doctor comes to you. I’ve only called them once, and I felt like they needed (there were two who came) a stretcher after climbing my 7 flights! It’s a good thing I didn’t break anything, because they never would have survived getting me down the stairs ;) Even though it wasn’t what I called about, they were concerned about my blood pressure, so they called a private ambulance to take me to a hospital. (That ride cost 80€, but after social security it was only 45€). It’s interesting to know that different hospitals in France have different specializations, so they won’t necessarily take you to the closest one. Later in the year for a different illness, I ended up visiting Urgences: Stomatologie (or the mouth ER). There are so many speciality stores in Paris, that I love that there are speciality hospitals too.

pretavoyager-mouthERWithin the large hospital complex, at Hôpital de la Salpêtrière in the 13th arrondissement, there is a specialized “urgences” (emergency room) for “stomotologie” – in other words, there is a Mouth ER! A co-worker suggested I should go there when I was experiencing a mouth issue. I was too stubborn, saying I would just go to the normal doctor. Well, eventually I ended up here and it was way cheaper than any doctor!

I’d spent enough time in France to realize that hospitals in France are fairly low on frills. Fortunately, for my first visit, I had planned appropriately: wore leggings, a comfy t-shirt, fleece jacket, socks, and packed a totebag with water and a snack, not to mention a book and extra battery pack and cord for my phone (not that I really felt up for the latter two, but at least I had the option). My first visit I wasn’t sure if I could eat (it was kind of why I was there in the first place), but once they let me out I was SOOOO happy to have this. On my two hospital visits I’ve witnessed other patients literally kicking and screaming because they’re starved. (That sounds really dramatic, but we all know how we get when we’re hungry and don’t feel good.).

pretavoyager-FrenchERwaitingroomI encountered very few TV screens in my hospital visits in France.

Like most hospitals around the world, you can expect a wait. But in France you get more of a 1960s/70s vibe, without any (well, maybe a few) flat screen TVs to keep you busy and distracted. Healthcare is more affordable because every facility doesn’t need to be state of the art. As long as I can get healthy, I’m ok with that.

My check-in was quite lovely as most of the information they needed was on my carte vitale (social security) card, which resembles a credit card with a puce (chip). Into hour four or five – on a Saturday afternoon – I started to feel a bit neglected in the small, beige, rectangular room with a checkered tile floor. There were only five people in the room, and most in worse shape than me. I eventually got wheeled into the private room, where I waited for awhile and then got some tests done. Then it was more waiting. Whew! 9 hours later: it was just a virus. I was free to go. The doctor told me I could go, but then nothing happened. I waited a bit longer before confirming I really could leave. I was utterly confused that in the land of bureaucracy there was no need for more forms, or the need to check-out. The thing that made me laugh the most was that no one had told me where/how to leave the hospital. I had been wheeled to various rooms and no longer knew where I was. Thankfully the biggest stress of that day had been finding my way to the exit– to where my friends were waiting to pick me up.

pretavoyager-FrenchERThe room where my blood was tested at a hospital in the 10th arrondissement. Notice comfy pants, socks and shoes. Don’t be afraid to bring your own blanket and water bottle too! 

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Christmas 2015 really came when my first [experience] bill from the “urgences” arrived and I only owed 29€. I later realized it was that “expensive” because of all the lab tests they ran. In spring 2016 I owed 6,90€ for my ER visit and 13,90€ for my follow-up appointment. Seriously, I spend more than that on meals every day! My coworker had encouraged me to go there from the start (even telling me about the “mouth ER”). The real irony is that it was so much cheaper than the 75€ specialist my generalist sent me to (more would have been reimbursed had I had a mutuelle at the time), and whose specialty seemed a bit different, and made me worse, not better. This experience was a small price to pay though in the realm of health care. Any mental blocks when it comes to hospital, is more than made up in the fact that it won’t make you bankrupt!

pretavoyager-FrenchhospitalA small section of the large room which was the “mouth ER” where I had my initial visit, as well as a follow up visit a couple weeks later. I felt a bit like I was time traveling through the décor, but all I cared about was that there was a doctor specialized in my issue who was talking to me.

 

MATERNITÉ
While I can’t speak directly to this experience myself, I’ve had enough friends go through it, and have made hospital visits, so I thought it was worth touching on. Before I freak you out by saying that you’re expected to bring your own towels, remember that having a child in France is a very low cost. (I believe it’s over $10,000 in the U.S. for reference).

My friends have stayed in the French maternité for 3-5 nights in general. This was not because they had any complications. It’s just how it’s done here. One friend had a 360€ bill for a 5-night stay, but that’s only because she had requested a private room. While it was not covered by Secu (social security), it was covered by her mutuelle, so the total came to 0€. She did admit not all of the visits leading up to the birth were completely covered, but again, that’s where the mutuelle comes into play. Another friend paid 60€/night for a private room and another 25€ supplement for her husband to be able to stay there too – all covered by their additional insurance.

Two other major differences regarding having a baby in France are the fact that maternity leave is much longer (it usually starts a month or more before the birth), and, after the baby is born, moms receive “perineal réeducation” (vaginal retraining), which is like a video game for down there to get things back and working ASAP. What can I say, love is important to French society, and the French love vacation (all 5-9 weeks/year + holidays).

 

In short, we Americans have the tendency to associate healthcare as something that is naturally and inevitably expensive. As the French would say, “C’est comme ça!” (that’s how it is.). However, in this case, nothing could be further from the truth. Healthcare can be affordable. It can support everyone who is sick, no matter who you are. Americans, just look to the rest of the world to see how it’s done – they’re onto something with universal healthcare. That’s why travel matters – you can see other way things are done, and learn from these experiences.