Health service in France

The French health service is one of the best; care is comprehensive and excellent, and waiting is practically unknown.

It is however, contributions based, which means that people do not automatically have health insurance entitling them to free healthcare, although of course doctors and clinics have to treat all emergency cases and since 2001, the system attempts to ensure that everyone has health insurance.
British people visiting France for short periods can transfer their British entitlement to emergency treatment via a European Health Insurance Card (which has replaced the old E111).
For EU citizens resident in France, rights to free healthcare for the first two years in France can be transferred from the UK (or any other EU country) via a form E106.  Those in receipt of a UK pension can also claim free health care using a form E121.
Otherwise, to get into the French system, you have to either live with/marry a French person (or a resident in France with healthcare) or be employed (or self-employed) in France.  The minimum requirement on the employment front is 60 hours a month for than three months  – which will automatically give you and your family the basic state cover (ie around 80% on average of your costs reimbursed) and if you want 100 per cent cover, you’ll have to do as 85 per cent of the French do and buy a private health insurance policy (une mutuelle) as a top-up.
Under certain circumstances (ie you become unemployed), French residents on very low incomes are entitled to free healthcare via a free health insurance scheme called the CMU – Couverture Maladie Universelle de base and a sister scheme called CMU-C (complémentaire) which is a mutuelle (ie top up insurance).
If none of the foregoing applies then currently, the only open route is via private healthy insurance, which can be expensive.  Legislation is currently changing however, so be sure to check for latest up-dates.  Before taking any action, phone CPAM (the Caisse Primaire d’Assurance de Maladie – the main French health insurance agency) on their English speaking helpline 08 08 20 90 42 12.  Be patient, lines are busy.
 
On the cards
The system is that you pay for consultations, treatments and prescriptions up front, and a proportion of your money is then reimbursed. When you pay, sometimes you are given a feuille de soins which you sign and send to your local sécu (ie CPAM). A proportion of the money is then reimbursed directly into your bank account. This usually only takes a few days. Reimbursements can be up to 100 per cent (ie for pregnancy and childbirth as well as a selection of serious chronic diseases), but are often less, which is where the mutuelle (top up insurance) comes in. 
Increasingly nowadays, you present your carte vitale (which looks like a lime green credit card and includes a chip containing information on your health insurance status) and then only pay the non-reimbursable portion of the costs.  If you have a mutuelle, you then send the bill for the non-reimbursed costs to them.  If your mutuelle is the CMU-C, you pay nothing and the bills are sent directly to CPAM.  
Medical practitioners are either conventionné or non-conventionné – ie they either charge the government-set prices for consultations, or they charge more. If they charge more, you will pay more, and the percentage reimbursed will still be calculated on the conventionné price.
Just as in the UK, you have to choose a general practitioner, but you can easily change if you like. There are plenty of doctors available; all of them are well trained and helpful, and many of them speak some English. If needed, French doctors will make home visits, even at night if required – especially for off-colour kids.  (Under 16s don't need to have a designated GP; you can call any doctor any time to treat a child.)  Be warned though, that if the doctor thinks the visit was un-necessary, you could end up paying a hefty excess fee, which will not be reimbursed.
If you do not designate a GP your reimbursements will be seriously affected. Naturally if you are geographically too far from your GP to consult him/her, (ie on holiday, working away from home etc) then there is no financial penalty for consulting another GP.
For minor ailments, a trip to the pharmacist can be a good bet; they are highly trained (it takes six years at university to qualify) and they give good advice free. They can also dress small wounds, and in certain circumstances (ie theft of luggage on a Saturday night) will dispense emergency supplies of prescription-only medicines without a prescription.
In most towns, pharmacies run a service de garde – ie an emergency night service. Some pharmacists also run a tiers-payant service for regular customers, where you only pay your share of the price of prescription medicines, and the pharmacist collects the rest from CPAM on your behalf.
It might just be worth noting here another difference between the French healthcare system and that in the UK.  Bedside manner.  French hospital doctors and surgeons are generally charming and polite, but are less likely than British doctors to present you with choice in terms of treatment because they tend to take the line that they are the specialists and they know best how to treat you.  So although you may well be given choices such as where and when you would like your operation, you are unlikely to be given any say in whether or not to have that operation.  French nurses also tend to take the line that they are there to carry out the doctor’s orders rather than to administer TLC.  So if you decline treatments such as suppositories (which are widely used in France) you are likely to be met with blank incomprehension and possibly even some hostility.

FACT FILE
* CPAM – Google ‘CPAM’ to find the CPAM website for your department
* www.ameli.fr – overall CPAM site, useful for keeping track of reimbursements
* www.cmu.fr – information about claiming free health cover
* Emergency telephone numbers – 112 = (general);113 = SAMU (ie ambulance); 18 = pompiers (fire brigade and first aid); and 17 = police
* Forms E121 and E106 (along with further advice) are available from DWP Newcastle.  (http://www.dwp.gov.uk/localoffice/disability/offices/du_newcastle.asp

TIPS
* Get your European Health Insurance Card before leaving the UK as it will show that you are entitled to emergency healthcare in France. (It will not entitle you to have chronic ailments treated, ie cataracts removed.)
* If you’re planning on becoming resident, contact CPAM as soon as you arrive. Guard your Carte Vitale with your life – replacing it can be a hassle.
* If the price of regular top-up insurance makes you nervous, remember that your child’s school insurance (www.mae.fr) can cover him/her for all accidents for as little as €25 (£17.23) a year.
* It is illegal in France to refuse help in an emergency so if the worst happens forget insurance; just get to the nearest clinic. The paperwork can be sorted later.
* If you incur costs for emergency treatment whilst temporarily visiting France without a European Health Insurance Card, once you get back to the UK you can still claim the money back. Start reading here: www.dwp.gov.uk/international/sa29/introduction.asp