Bonne Sante

Earlier this year, my adventurous young niece Camilla fell awkwardly while cycling in France.  She thought she may have broken her shoulder and went to the urgences of the local hospital.  On arrival, she was immediately seen by a nurse and within 20 minutes, had an x-ray and a doctor’s reassurance that the shoulder was merely bruised.  The cost was 45 euros and she was given the x-ray film and receipt of payment.  It was left to her to recoup her expenses.    Camilla discovered that the massive waiting areas of most British casualty departments do not appear to exist in France and that ‘urgences’ were treated with urgency. It was in stark contrast to an experience in England a few months earlier when she had a suspected broken ankle following another accident.

‘I couldn’t believe the difference,’ she says.  ‘In England, as my injury was not serious, I had to wait for several hours, whereas in France, I was treated like a valued client.’

The last thing most of us think about when visiting France is falling ill, but as with their food and wine, the French also boast an excellent albeit expensive health system.  France devotes a greater proportion of its national income to health than defence or education and is the second largest spender on health after the USA. British visitors, being fellow members of the European Community, are entitled to use the system under a reciprocal healthcare agreement.

Unlike England, French healthcare is not free at the point of delivery but, depending on the treatment, a proportion of the cost, usually around 70% is refunded at a later date.  However to obtain the refund, a validated form E111 must be produced.

The E111 is available from main UK Post Offices and as long as you know either your National Health number or your National Insurance number, it can be validated immediately.  At the end of this year, it will be replaced by the European Health Insurance Card which will be issued in much the same way.

It is worth keeping your E111 with your passport during a visit to France in case you need it.  If there is an emergency, such as a suspected heart attack or serious accident, you should telephone 15 for your nearest SAMU(Service d’Aide Médicale d’Urgence) unit.  SAMU is an emergency service that works closely with local public hospital emergency and intensive care units.  Its ambulances are manned by medical personnel and equipped with cardiac and resuscitation equipment. 

            If like Camilla you are physically capable, you can go to the urgences of  a hospital which will be indicated by the international hospital sign of a white ‘H’ on a blue background, or alternatively a doctor.  The local town hall or pharmacy will have details of where to find a doctor or dentist and it is important that he is conventionné with the French health system.  He will then charge a fixed amount for treatment.  If not, he will be termed non-conventionné and the bill may be much higher with only a small proportion of fees reimbursed. 

After treatment, you need a signed statement of the treatment received , une feuille de soins – you cannot claim a refund without it.  You will be charged for the treatment as well as for any prescribed medicines, and the amount(s) should be shown on the feuille.  When getting prescribed medicines, the pharmacist will hand you back your prescription and you should attach it to the feuille in order to claim a refund.  Medicine containers also carry detachable labels vignettes, showing the name and price of the contents.  Stick these in the appropriate place on the feuille and sign and date the form at the end.  You can send your application for a refund, consisting of the feuille, any prescription and your E111, to the nearest office dealing with illness, the Caisse Primaire d’Assurance-Maladie or CPAM while you are still in France.  The refund will be sent to your home address later but may be subject to a bank charge.  Before sending the money order, the French authorities will send you an itemised statement of the amount to be refunded.  This refund process usually takes around two months.  Alternatively, you can keep the paperwork and sort it out on your return to the UK through the Department of Work and Pensions in Newcastle-upon-Tyne.

The same formality as above is required for any out-patient hospital treatment. In-patient treatment is slightly different and the hospital doctor will issue you with a sick certificate, une attestation.  The hospital should then send notification of your admission, avis d’admission – prise en charge, to the local CPAM along with your E111.  The CPAM should then pay at least 75% of the cost direct to the hospital.  You will pay the balance as well as a daily hospital lodging fee, unforfait journalier.  The 25% balance and the forfait journalier are non-refundable.

An E111 covers you for any treatment that becomes necessary during the course of your visit to France. This includes renal dialysis and oxygen therapy, but advance arrangements must be made through your UK NHS unit.  In fact treatment of any chronic or pre-existing illness including maternity care, which requires on-going medical attention, is included as long as it is not the purpose of your visit.

Most French residents have an insurance, une mutuelle, to cover the percentage of costs not reimbursed, and those with serious illness who cannot be insured, receive 100% reimbursement, as do retirees. 

The French system is excellent, expensive and effective.  French women have the highest life expectancy in Europe at 81 (73 for men) but costs are spiralling and it is generally recognised that, sooner or later, there will have to be some extensive economies implemented.  But for the time being at least, we can all benefit from this luxury health system if necessary, not just the young and accident-prone like my niece. Rest assured that any illness or disability is not a barrier from visiting La Belle France.

FRANCOFILE

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© Judith Cameron