State and private health services coexist and overlap, state healthcare often being identical to private treatment. Those who qualify for state healthcare include employees, the self-employed contributing to French social security and EU pensioners who have reached retirement age in their home country, as well as the dependants of all these. If you qualify for state healthcare, you must register at your nearest social security office (caisse d’assurance maladie – listed on www.ameli.fr and in the information pages of phone books). You must present proof of employment or self-employment in France or form E-106 or E-121, proof of residence (e.g. a property deed, rental contract or proof of registration in your commune) and your passport. After registration you’ll receive a social security card (Carte Vitale – soon to be superseded by the Carte Vitale 2), the size of a credit card, with your social security number on it. This should be presented whenever you require medical treatment, although if you forget it you can complete a form instead.
In some cases (e.g. consulting a doctor or dentist), you must pay and claim a refund afterwards; in others (e.g. when obtaining prescription medicines from a chemist) the refund is made ‘on the spot’.
You’re required to appoint a regular doctor (médecin traitant), who can be any registered doctor. If you need specialist care or (non-urgent) hospital treatment, you must first consult your regular doctor, who will refer you as appropriate.
It’s usually possible to get an appointment the same day and doctors allocate around 15 minutes per patient so you’re rarely kept waiting long. Most doctors have an ‘open surgery’ (consultations libres) for around two hours per day, when you can go along without an appointment and wait your turn. Out of hours, there’s a number you can call to be put through to the nearest duty doctor. French doctors are reluctant to make house calls.
Not all hospitals offer emergency treatment and you should find out where the nearest Accident & Emergency/Casualty department (Urgences) is and how to get there from your home. In an emergency you can dial 15 for an ambulance (provided by the Service d’Aide Médicale d’Urgence/SAMU) but, if you aren’t admitted to hospital, you may be charged for the service; alternatively, you can call the fire brigade (on 18), who often provide a better service and won’t normally charge a fee.
The French are pill poppers (hypochondriacs) and a visit to the doctor usually produces two or three prescriptions for potions, tablets and ointments, even for a minor ailment – not for nothing is the government increasingly ‘encouraging’ doctors and chemists to offer generic alternatives to branded medicines and removing hundreds of medicines from the approved reimbursement list.
Unlike in the UK, for example, medicines aren’t ‘made up’ by a chemist while you wait but are all pre-packaged and simply retrieved from a shelf by pharmacy staff – which doesn’t mean that they aren’t highly trained and unable to give detailed advice on when and how to take medicines and even offer ‘prescriptions’ of their own for minor ailments without your needing to see a doctor. This system has the disadvantage that you often end up with ‘spare’ medicines – if, for example, you need only eight tablets but the packet contains 10 or 20.
It isn’t possible to buy strong medicines such as antibiotics over the counter, however, and chemists’ shops offer few non-medical products – they may stretch to babies’ dummies and hot water bottles but no further.
Prescriptions issued by doctors are subsidised and you pay between nothing (e.g. for babies’ medicines) and 100 per cent of the price (e.g. for most contraceptive pills), not a fixed amount per prescription. Some or all of the cost may be reimbursed if you have complementary insurance. There’s no discount for medicinal products purchased without a prescription.
If you have to go to hospital, France is one of the best countries to be in, as hospital facilities and services are generally second to none and waiting lists virtually non-existent for most procedures. In fact, during holiday periods – espcially the summer – many hospitals are half empty, as the French make sure nothing spoils their vacances (the only problem is all the doctors are also on holiday).
Public hospitals provide two- or four-bedroom wards with ensuite bathrooms and possibly a TV. In private hospitals (or private rooms in a public hospital), patients usually have individual rooms. Visiting times are usually flexible. The only possible criticism of French hospitals is that hospital food is rarely haute cuisine.
If you have a scan or an X-ray, the results are given to you and it’s up to you to take them to your doctor. Many people have an impressive dossier of medical records, which should be kept in a safe place, as copies are impossible to obtain.
France has one of the lowest infant mortality rates in the EU, but having a baby is a highly clinical experience. Ante-natal care is good – mothers are required to have at least two scans, monthly blood tests and check-ups, and may attend ante-natal classes. Don’t, however, expect to be asked to provide a ‘birth plan’: home births are practically unheard of, as are water births, birthing balls, etc. Even giving birth on your side or sitting up is usually frowned upon, although hospitals are beginning to be more ‘progressive’ in this respect. Pain relief, however, starts and ends with an epidural (péridurale) – gas and air aren’t available. Partners are allowed to be present at the birth but not if there’s a complication or a caesarean must be performed (which is more common than in many other countries).
Mothers and babies normally stay in hospital for five days after the birth, although it’s sometimes possible to leave earlier. However, in most cases subsequent post-natal care is carried out by doctors or baby-care centres (centre de protection maternelle et infantile/PMI). Don’t expect home visits from doctors or midwives to check on your of your baby’s health – the onus is on you to go for regular check-ups.
Excerpted from “Culture Wise France” which can be purchased from Survival Books