THE FRENCH HEALTH SERVICE
- continued
The funding of health in France is based mainly on obligatory
social insurance schemes. For example both employer and
employee contribute a share. In respect of the employee
this appears as a statutory deduction on the salary slip.
These contributions are passed on to one of various "Caisses".
The actual "Caisse" will depend on the trade,
profession or business of the individual. Approximately
70% of health funding comes from this source.
For most expatriates coming to live in France and particularly
those who are retired or have taken early retirement they
will register with the "Caisse Primaire Assurance
Maladie" (CPAM) of which there is a nationwide office
network.
The other underlying principle of health funding is that
it is a tributory system. What this means is that although
there are these (quite high) obligatory contributions
this does not cover all medical and dental costs. 70%
is the norm. It is up to the individual to pay the balance
either directly or via a "top up" insurance.
These are called "polices complementaires" and
"mutuelles". Only in the cases of those defined
as the 30 most serious diseases/illnesses and major surgery
will 100%, or nearly 100% of the costs, be met by CPAM.
Even being diagnosed with one of these diseases eg; Parkinsons
Disease does not automatically mean full reimbursement.
It will depend on how advanced the condition is and it
being certified with CPAM by the Medical Practitioner.
In France there is a freedom of choice as far as a GP
or Specialist is concerned. In the latter case direct
access is usual and referral from a GP not necessary.
There is also a choice of hospital and the state and private
hospitals complement each other. There is no discernible
difference in the standard of care. Indeed it can be less
expensive in a private hospital because the bureaucratic
and administrative costs are often lower and the private
hospitals will not have a teaching function.
The cost of each individual treatment is determined by
the "Tarif de Convention". Medical Practitioners
and hospitals/clinics (the majority) that conform to this
tarif are described as "conventionnée".
Those that do not are "non conventionnee" and
can charge what they like. There are healthcare and pension
benefits for those who are "conventionnee."
A routine visit to a GP "conventionnee", for
example, is set at €20. CPAM will meet 70% of this
cost and balance is paid by the patient or his insurer.
The patient pays the doctor directly and applies to CPAM
for a reimbursement. In the case of potentially expensive
treatment such as hospitalisation then arrangements can
be made for CPAM and the "mutuelle/police complementaire"
to pay direct. If a patient chooses "non-conventionnee"
treatment CPAM will only reimburse 10% of the tarif.
It gets worse! Although this tarif is the standard, Practitioners
are allowed to charge more than this provided it is "tactful
and reasonable" and Specialists, whose tarif is set
at at €25, will almost certainly do so. This surcharge
is known as a "depassement". Many Specialists
will charge at least double the tarif. However CPAM will
only refund 70% of the tarif. It is factors such as "depassements"
that can affect the choice of a "top up" policy
of which there is a bewildering array.
This is only a brief summary of healthcare system in
France. It is a complex subject and individual queries
are welcomed.
For the vast majority of those legally resident in France
(regardless of nationality) registration with CPAM or
other "Caisse" is now obligatory. Registration
with CPAM can be as complicated as the nature of the organisation
itself
|
