- the connoisseur's guide to France
page provides a general overview of the French health care system
how it works. The French health care system, in spite of its problems,
is ranked by
the World Health Organisation as being the best in the world.
French health care system
and how it works
health care system
hr chemist / pharmacies:
a) 84, av des Champs-Elysées 75008, tel
62 02 41
b) 6, place Clichy 75009, tel
74 65 18
62, Avenue des Champs-Elysées
0143 59 22 52
1 rue Auber, 75009
65 88 29
Daily 3 pm - 11pm
01 46 21 46 46
is generally recognised as offering one of the best,
services of public health care in the world. Above all, it is a system
that works, provides universal cover, and is a system that is strongly
defended by virtually everyone in France.
health care system in France is made up of a fully-integrated network
of public hospitals, private hospitals, doctors and other medical
service providers. It is a universal service providing health care for
every citizen, irrespective of wealth, age or social status.
health care in France.
The French health care system is funded in part by obligatory health
contributions levied on all salaries, and paid by employers, employees
and the self employed; in part by central government funding; and in
part by users who normally have to pay a small fraction of the cost of
of health care that they receive.
Economic difficulties in France in recent years, combined with an
ageing population, mean that the system is not working as well in 2019
as it used to. A&E staff and hospital staff have come out on
for better pay and conditions, since although waiting lists and waiting
times are generally
short, black spots have begun to emerge. Caps on numbers of medical and
nursing students have recently been raised, and levels of
reimbursement for non-essential treatment have been reduced –
though complementary and contributary health insurance schemes, known
as "Mutuelles", have take up some of the difference.
In European terms, the French health care system is among the
better funded in terms of GDP, and average in terms of GPs, hospital
beds and nursing professionals, as the table below shows.
Compared specifically to the UK, funding and number of GPs
10% higher, while there are more than twice as many hospital beds and
40% more nurses and midwives than in the UK.
share of GDP
|Number of GPs for
per 1000 population
(figures: Eurostat 2013 or 2014).
In addition, the cost of
medicines in France is among the lowest in Europe. A UK Department of
Health survey in 2008 of the cost of medicines in the EU and the USA
found medicine prices in France about 10% less than in the UK.... and
well under half the
price of the same medicines purchased in the USA
the French health care system works
The French health care system is relatively simple for its users - that
means virtually everyone living and working in France, or
dependent on someone living or working in France, and every pensioner.
Primary health care is provided by a network of 23,000 general
practitioners (in French, médecins
(a ratio of 1 GP per 2600 inhabitants). Most GPs are
self-employed professionals, and work either on their own, or in group
practices. Citizens are free to choose the GP the want, and sign up
with him or her, as their personal doctor. Citizens may also consult
any other GP they wish, but only the personal doctor with whom they are
registered is authorised to refer patients to a specialist or to
another health care provider - nurse, physiotherapist, etc -
further care under the health care system.
cases, patients have to pay a flat rate fee for any visit to a general
practitioner. The cost in 2019 is 25 € per visit,
time taken, but is higher for visits to surgeries open at night or at
weekends, and for home visits. Most of the cost will then be
automatically reimbursed to the patient by his state-run health
insurance provider, leaving the patient with between zero and 6 Euros
to pay for a standard trip to the doctor, depending on the type of
health care insurance he has and the age or medical condition of the
Virtually all GPs in France are
"conventioned", i.e. they have signed a contract with the national
health insurance scheme to provide their services in the framework of
the national health service, at the rates agreed nationally.
A&E services (les
are part of the national heath care system. All cities and large towns
have a service know as the SAMU, which is the emergency ambulance
service. Paramedics and medics from the SAMU are called out in the
event of accident or emergency, and provide on the spot assistance
before transporting the sick or injured to A&E or other
units at the nearest hospital providing them.
The SAMU ambulance service is only used for accidents and
emergencies. Other routine ambulance work is carried out by private
ambulance firms, subcontracted to the state health care system.
Specialist health care is provided by thousands of specialists in all
branches of medicine, in towns and cities throughout France.
Specialists charge higher fees than general practitioners, but again
there are official rates agreed with the national health service, which
form the basis on which patients are reimbursed. A large number of
specialists apply tariffs that are higher than the official rates; in
such cases, patients will either be reimbursed according to the
standard rate, or else at a higher rate, if their health insurance
provider provides for this.
As stated above, visits
to specialists in France are only reimbursed by the health care system
at the full rate if the patient has been referred to the specialist by
his own GP. Citizens may also visit any specialist they want, without
getting referred by their own GP; but if they do so, the cost of their
specialist visit will only be paid back at the basic GP visit rate,
however much they paid.
The main exception to this is
for dentists: dental care is covered by the health service, but has its
own tariffs and reimbursement rates. Generally speaking, most basic
dental work - fillings, extractions etc. - is carried out and
paid for under much the same conditions as other specialist health care
treatment. Other more complex operations are also reimbursed, but at
Many specialists divide their time between
consultancy work in their own surgery or group practice, and hospital
work. Some work exclusively in their own practice, and some work
exclusively in hospitals or clinics. It is important to remember that
specialists working outside state hospitals do so as self-employed
professionals, offering a private service that is paid for by the
patient, and then rapidly reimbursed by the state health insurance
GPs and specialists prescribe medicines and other parapharmaceutical
products that must then be obtained by the patient from a pharmacy. It
is unusual for GPs, except perhaps on night visits, to have any
medicines available with them.
At pharmacies, the
pay-and-get-reimbursed principle again applies, with one major
difference. Whereas with doctors' visits, the patient pays the full
amount due, and then is reimbursed later minus the percentage he has to
pay, with pharmaceuticals the patient pays only the part of the cost
that is not taken care of by the state health care system.
Thus, for a typical visit to the pharmacy with a
for drugs costing, let's say, fifty euros, the patient will be charged
between zero and fifteen Euros, depending on the nature of the drugs
and material prescribed, and the health insurance cover he has. There
are four basic rates of reimbursement for medicines: 100%, 65% (the
normal rate) 35% and not-reimbursed. Complementary health insurance
plans (known as les
) will push these rates up considerably.
There are two sorts of hospitals in France; generally speaking these
are known as hôpitaux
when they are state run, and cliniques
when they are privately run. Most private cliniques
are state approved, and can therefore work for the national health
service. Many specialists work in both state run hospitals and in
private clinics: since they are self-employed professionals, they can
sell their services to whatever hospital or clinic will pay them.
Both GPs and specialists can refer patients for
treatment if it is deemed necessary; and within the framework of the
health service, they can send them for treatment in either a state-run
hospital or a private clinic, whichever they consider to be best for
the purpose, or to provide the fastest service.
the framework of the French health care system, patients are only
billed for a very small proportion of the cost of their stay in
hospital; the most significant charge that the patient must pay is an
18€ per day hospitalisation fee, basically a contribution to
and lodging provided by the hospital. In most cases, most or all of the
rest of the bill is paid for by the state halth insurance scheme and
complementary health programmes.
The health care system is coordinated centrally by the Ministry of
health, and administered by the actors in the service, hospitals,
clinics, doctors, other health care providers, pharmacies, ambulance
The transfer of funds through the system
between patients,and health care providers is ensured by the National
Health Service, the "Sécurité
", and often subcontracted to complementary health
insurance funds known as Mutuelles
The system is highly computerised, since the introduction over ten
years ago of a health insurance smartcard known as the Carte Vitale .
The job of bringing in the obligatory
insurance contributions owed by employers, employees and the self
employed, is undertaken by an organisation known as the URSSAF.
Like health insurance schemes everywhere, the French state health
insurance program has difficulty making ends meet, and relies
increasingly on topups from the general budget of the state. An ageing
population and the explosion of health care costs due to increasing
expectations and the development of expensive new processes and
medicines, have put enormous strains on the system. The rates
reimbursement have been reduced in recent years, and some contributions
increased. People complain of the cost, but at the same time very few
voices are ever heard in France calling for a reduction in the services
In short, almost everyone in France knows
that France has one of the best health services in the world, if not
the best, and one that is the envy of many other countries. New
solutions will be needed in the years to come to make sure that the
system continues to provide this high level of service; but there is
more or less total consensus in France that whatever the cost may be,
it will be worth it.
France / USA
People in France, who have lived with their national health
service system for all or most of their lives, and know first hand how
well it works, have been very perplexed by the passions aroused in the
United States by Obamacare. They have even greated difficulty
understanding how Americans could elect as Obama's successor Donald
Trump, a man who pledged to abolish universal health care in the USA.
most conservative forces in French life support the national health
service and have difficulty understanding why some people in the USA
imagine that an obligatory health insurance scheme for all could be a