Relax, monsieur, you're well cared for: The French give their health care system high marks. Photo taken at the flea market in Nice.
Readers of this blog who are thinking of moving to France often send me questions, and one of the main ones is: how’s the health care in France? What to do about medical insurance?
I decided to write about French health care this week, and my decision was prompted by reading the Time Magazine cover story of last week: Bitter Pill: Why Medical Bills are Killing Us.
I read this amazing piece of old-fashioned investigative journalism, about WHY a cancer drug in the states costs the pharmaceutical company $300, is sold to the hospital for $3000, and is billed to the patient for $13,000. Why you may be charged $77 for a box of gauze pads that you could buy for a couple of bucks. Author Steven Brill tells us who is lining their pockets with our money. I don’t think I’ve ever been so furious, after reading it. If were up to me I’d make it required reading for every American. People, we are being robbed. These bandits make the villified bankers look like benevolent philanthropists.
The French system is day to America’s night. The World Health Organization rates the French system the best in the world (the US is 38th, though it’s by far the most expensive in the world). Life expectancy? The UN ranks the French 7th in the world, the US checks in at 40th.
We’ve lived with the French system for 10 years now, and been through small surgeries, procedures, routine care, and my husband’s bike accident which put him in the hospital and in-patient rehab for two months. Though French health care is not perfect, it’s pretty darn great. It’s cheap for us, and basically ‘free’ for every French person, though of course their tax rate is higher. But they get really great value for those taxes, and the system is completely equitable.
The first thing you’ll notice in France is this: doctors don’t have staff, unless they’re in a group practice, in which case they have a receptionist. If you’re French, you hand them your carte vitale, deal done. As expats without a ‘green card’, as they call the carte vitale, we write them a check on the spot ($30 for a GP, $40-$50 for any specialist). No paperwork, no insurance to file for doctor or patient, if you’re French. Contrast this with the states, where each doctor will have between 3 and 7 employees, most working on billing/administration. (Imagine what that adds to your costs).
In hospitals, we’ve gotten very good care–state of the art and top of the line. Unlike in the states, everything is priced at something close to the actual cost, so the prices are quite reasonable. Example: A trip in an ambulance in France runs about $50 euros; in the states it’s about 20 times that much.
But as an expat, will your insurance apply in France? That depends on your policy; we have military insurance so we're covered. Medicare does not apply in France. Ex-pats can buy special insurance policies to cover them in France and because health care is so much cheaper, the policies are cheaper too. If you’re a French resident with a Carte de Séjour (resident card), you can buy into the French system under some circumstances, the cost of which will be a percentage of your income (Visit Expatica, or Americans in France). PHOTO: The French live longer—is it the wine, the relaxed lifestyle, or the health care?
Now back to that Bitter Pill. Warning: if you are well when you read it, you’re going to feel quite ill when you finish. I couldn’t sleep the night I read it; Jon Stewart says that by the end of the article his hands we’re shaking and he was screaming. So what to do about it? I’m contacting my legislators toute de suite for a start, I hope you will too. As always, comments are welcome, I’m very interested to hear your take on the article, and on French health care if you have experience with it.
In the COMMENTS: Last week, an easy dinner menu. Natalia, wow, now that's a great menu for spoiling your guests! Anne, I love the idea of a spciy mustard in the dressing. Barbara of The Wise Collector shares a book on French cuisine, Bouquet De France; An Epicurean Tour of the French Provinces
sounds like a must-read. Ido, felicitations on the baptism, and thanks for asking about my book–to be published at last this spring, I hope! Suzanne, an iron skillet should work perfectly for the tian and roast, I use mine for just about everything anyway. Carrie (of Season it Already!), come on over anytime!
26 thoughts on “A Healthy System: French Medical Care”
We have found the French health care system excellent, and if the problem is life threatening it is totally free. There is no situation where you need to pay up front, although you may need to pay for certain procedures after they are not expensive. If you had to pay for a visit to a GP it would cost €23 no matter how long the consultation.
You are right on target with your assessment of French healthcare, Lynn. LIving there much of the year, I have had to use the system a few times as well as having to interact with a hospital emergency room for other Americans. From triage to treatment, it was a very well run machine. I talked about it for weeks. Before leading tours in France, I was an intensive care nurse so had the knowledge to judge. In another situation, a dear friend was admitted to the hospital with a cardiac condition….private room with monitoring was 90 Euros…and he even had a terrace. And they don’t kick them out when they are still so very sick or recovering from surgery. I could go on and on……lots of experience in this arena in France. All this said, there is unbelievable home health care follow-up. And finally, a word about meds. We had a guest with an infection requiring Cipro (American physician with us prescribed) . I went to the pharmacy with the physician and explained the situation. No problem, pharmacist provided a 10 day supply…..cost 18 Euros. The physician told me that this would have been at least $200 in the USA. Sorry for the long rant. You hit a nerve.
I am happy with the Italian healthcare system as well. All of the above is true for me, and I love the 24 hour/ day on call doctors, even in my tiny village. House calls are normal.
Yes, thank you for sharing this Lynn. Illuminating and disturbing.
Action and reform stateside much needed. Good to learn about the excellent care here. We are with you on this for sure.
I agree with all the above comments: As an ex-medical career person in the States and an American – I now live in France! Need I say more!? The TIME article was appalling, and although I knew all that, it still made me sick to my stomach.
And of course, as you are aware, my husband was diagnosed with a cancerous tumor on his pancreas and had to undergo a Whipple operation – which I won’t go into other than saying it is an extremely extensive rearrangement of one’s digestive tract. He spent a month in the hospital – and has had to have several other followups/stays for at least 10 days. By extremely fortunate circumstance, we ended up with one of the best Internal Surgeons in probably at least France if not other places who was an MD and a PHD. He not only checked my husband at least once a day, but called the hospital every day he was on vacation to see how his patient (s) was/were doing, told us up front that if, at ANY time, we had ANY questions or concerns to call him, saw us on Christmas Eve and additionally two Sundays ago. So for the entire process (this includes his pay, the anesthesiologists, nurses, time in the hospital, visiting nurses, meds etc.) it has cost us in $’s about $35,000 without the French Carte Vitale and waiting for our U.S. insurance to kick in. In the States? Think at least $500,000. The French Health care system is awesome. The only problem we have discovered is that no doctor or surgeon is allowed to “advertise” since everyone is supposed to be the same. So when you do find a great doctor, the French people want to know who it is because they have no idea who does what or is really good OR conversely really bad.
Dear Lynn,
We are retired in North Carolina. My husband just had knee replacement surgery which cost $77,000. He was in the hospital for two nights. The itemized bill from the hospital was horrific. We all know our health care system is a fraud, but we still are not willing to do anything about it. What more will it take to wake up the American people?
You do have to pay up front. The cost is then reimbursed into your bank account, minus one euro pervisit to your GP.
There is also a one euro charge for every visit to the pharmacy.
Sometimes you receive a “feuille de soins” which you have to fill in and then send to whichever social security department looks after youtr healthcare and then, eventually you are reimbursed.
If you have a mutuelle, the part of the cost which is not covered by your state cover, usually 30% is reimbursed by your mutuelle.
There can be problems when you may need something which is out of the ordinary, especially if you need treatment outside of France. I know from experience that the french system totaly misunderstands this, and I have had a long running battle with them wihich has been taken up by the DoH in UK.
we have changed our medicin traitant, GP, because we found that one person working on their own without a computer did not give us the care we needed.
I have had to stay in hospital overnight and I received very good care.
As is usual in France, the problems are nearly always with the paperwork!
As one French doctor said to us when we ended up at the famous Timon Hospital in Marseilles:while on vacation in France: ” We give great care here in France, but we don’t work on the weekend.!” My husband was left to languis in great discomfort from Friday afternoon until Monday morning when the ENT doctor returned to his post. The cost was permanent deafness in one ear because the steroids were administered too late. I’ll stick with the imperfect US system.
I was in Paris early December and came down with another case of acute bronchitis (my lungs are my weakness). Having had pneumonia last August fort he third time, I wasted no time seeing someone. Fortunately there was a clinic next to my hotel so I made an appointment and was seen later that day.
My physician felt it may have been early stage pneumonia so she ordered a chest film and gave me a prescription for an antibiotic. I got the film and met with the radiologist to review the findings all within a short hour, then got the script. The radiology team also gave me a printed copy of the film for my records.
The cost?
Physician: 23 euros
Chest film/radiologist consultation: 75 euros
Rx: 14 euros
These prices are regulated by the French government so there is no wiggle room for clinicians to charge otherwise.
When I returned to the US, I submitted my expenses to my health insurer. Their response? “Oh, your co-pay is $100 so there is no reimbursement.”
To the point of the author, if we had less administration and just better health care, we would all be a lot better off.
And I am a clinician!
As a Yank in the UK, I am very happy to have the National Health System here. It is fair and compassionate. I hope the USA changes as it is a criminal system….
I am glad to hear so many people are happy with the French health care system. We recently moved back to the US from France. Unfortunately,we were mostly disappointed with the health care staff in France. The overall French health care plan and system is great and is very cost effective, but I didn’t find the staff to be as knowledgeable compared to most US medical staff. I was impressed with the pharmacists though, they were very competent and knowledgeable. We saw a few doctors while we were there and liked that they didn’t throw all of these unnecessary medications and diagnoses at us,but when I questioned them about a few things, they were talking about things from the 80’s and 90’s and not up to speed on current treatments and meds etc. I was very surprised and showed one of the elderly Drs the new literature from the last 10 years!He didn’t want to admit he didn’t know anything about it. The other one was rather young and just didn’t seem educated enough to be a Dr. Also, the school nurse was not fit to be called a nurse,she had no idea about basic first aid or what to do with a child’s head injury.
I am very award of these facts from the Time article and it disgusts me that we don’t have a better system for our people. I do hope something is done about this soon!!
Ah yes, Lynn. Public health care and public higher education (not to mention early childhood education)–the great American embarrassment. Don’t get me wrong. I’m happy and proud to be an American, but I regret that we haven’t gotten our heads around the notion that if higher taxes mean more benefits to all, then it’s a good thing. I won’t go farther down this rabbit hole here.
My own health insurance (which is excellent coverage at Kaiser’s HMO in California) in retirement prevents me from being out of US for one day more than five months out of the year, which is why I will not be relocating to France despite my desire to do so.
I have sought medical health for my children while traveling in France. Superb service and so easy to access. If I have to need medical treatment outside of US, let it be in France!
Thanks for making it possible for me to speak my piece.
Chris
Salut
Having recently been released after a 15-day hospital stay for heart surgery, I’m very familiar with our system. It’s broke and getting broker under Washington’s guidance! The facilities and equipment are state of the art, the medical personnel are excellent, but the current health plan and its management are un-sustainable financially in its present form…IMHO. Rationing of benefits will be the only alternative if changes are not made.
Incidentally, my cardiologist can speak fluent French and was trained overseas
@Susan Hermann- I find that incredibly odd that your husband would be left over the weekend. My son came down with a bad fever, ended up having a double ear infection, and was in the ER on Christmas Eve (along with many other people) where he was treated promptly and with care. There was even a troupe of volunteer clowns that came around the children’s ward to cheer the kids up!
I have never had more sane, reliable, affordable care than the 5 years I lived in France. I could always afford to see a doctor, the DR took time to address ALL of my concerns (not just a quick 10 min and shove you out the door as so often happens w/HMOs here in the USA) and they would make housecalls!!!
Perhaps the most ridiculous aspect of the American healthcare system is the fact that it is basically linked to employment. Why should my employer get to make choices about my family’s healthcare? Currently, I live in the US and have a good job, but if I had to have my son and my husband on my insurance it would take nearly 45% of my monthly pay. So I would have to decide if I wanted to pay my rent or have insurance. We are getting royally hosed, Americans. Look into the laws in your state. Often times there is a LAW (there is in OR) that insurance companies are guaranteed to make a profit. That is the most disgusting law/idea/policy I have ever heard of. We put profits WAY above people and our health as a nation.
@SFF- Thank you for this article! Love your blog 🙂
Most doctors in France actually do work on the weekend, at least on Saturdays. Emergency rooms are always open, and there are always specialists on call. (Information from my French medical resident roommate plus personal experience). Your husband not being seen on the weekend was obviously a major fluke, or there was reason to believe it was not urgent, and both events could easily have happened in the US as well.
The unfortunate cost of this cheap health care is that many doctors, particularly GP’s, have to work extreme overtime to get close to the kind of wages we would expect someone who studies 11 years to earn. The reimbursement level of Social Security (i.e. the 23 euros per visit for a GP) has not risen with inflation, and many people still think it’s expensive, so they visit GP’s with thier 5 children and expect one appointment for everyone, and complain if the doctor doesn’t want to spend 2 hours for 23 euros. Sometimes the actual cost of a procedure is higher than the reimbursement level, so doctors that are in the public sector and don’t claim “dépassement d’horaire” would actually lose money by performing such procedures. This is information coming from my medical-resident-roommate who hears from the medical community. Not that costs need to be anything comparable to the US, but the standard fee should be raised a bit in order for doctors to be earning something closer to what they made 30-40 years ago.
Also, the mutuels (the extra insurance that covers the last 30% that social security doesn’t) are almost as bad as American insurance. They take your money every month but actually pay almost nothing. I’ve heard numbers like an average of 40 euros per year paid out per mutuel-holder. I don’t have one (I’m a french resident with a student titre de sejour as I’m in grad school here, but I have a carte vitale and so pay the same as Frnch people. I had to buy in to the system when I paid my tuition fee, something like 150 euros per year)and neither does my roommate, because it’s kind of a waste of money. All life-threatening emergencies are 100% covered by the state.
Just sharing some observations on the last seven weeks of my life helping my 87-year-old aunt following a fall. She was admitted to one of Wisconsin’s largest (and best) hospitals. I won’t go into all the details, but just share quotes from the doctors, nurses, and staff.
1. From the chief of staff—”the days of patient centric care in this country are over. Decisions will be/are made by the government, not the physicians or hospital staff.
2. From the head RN (day shift)—”people in this country don’t realize what we are getting. It’s only going to get worse and the elderly patients will be hit hardest.”
3. From the head of the patient advocate staff—”you used to come to the hospital, get cared for, and stay until you were 100%. Now, we will be discharging people before they are well.”
4. From the administrator of an assisted living facility—”no doubt our healthcare system wasn’t/isn’t perfect, but we’ve made it worse.”
Sorry, I like the old system, even with it’s flaws. I want the best care available and I want to be cared for by professionals that know what the heck they’re doing. And, full disclosure, I come from a family with healthcare backgrounds. My mother was director of nursing at the above mentioned hospital and director of nursing for the state of Wisconsin. My aunt (the one I’m writing about) was dean of the school of nursing at a college here in the state.
The American should get their health care in India.
Piere was in the best private hospital in New Dehli for 5 days in a de luxe room which is worth a 5 stars hotel.
Had the best care he could dream of.
Was asked each morning and evening what he wanted to eat.
A tray with beautiful food was offered to me 3 times a day.
Given medicines for a week when we left.
The whole thing for 1000 Euros.
The cardilogist had been trained in England and America.
This hospital has 600 beds a third of which is occupied by foreigners….. No wonder!
Wow. A very eye-opening article you’ve shared. It’s frustrating when people here in the U.S. complain that they are going to have to pay for the care of the unemployed. However, no one even bats at the cost. Well, they talk about how crazy it is, but we just take it at face value and don’t question it.
It’s also crazy that some people will not go to the doctor or get their cancer meds if they know they can’t afford it.
I’ve always loved the idea of the way health care in France, but never experienced it first hand.
It’s just that the U.S. is so upside down in this right now, how could it ever make such a big change? Will it ever back down to lowering costs? What would force it?
A very interesting topic, for sure.
Lynn, you are right on about American healthcare, and from reading all the comments about healthcare in France, my response is that, as in other areas, the French simply do it better. If Americans would get smarter, be more supportive of Obamacare, for ex., instead of glorifying our money-hungry insurance companies, we could use the French system as a model to reform our healthcare. I also want to add that it seems to me that one reason for French longevity may be less stress. I found that while I was there, I felt stress free.
This is really interesting reading; thank you Lynn for starting the dialog. I haven’t seen the Time article (yet) but will try to get hold of it.
Shameful is all I can say. I, too, am retired in N.C. and we have very good access to wonderful healthcare at UNC. So far, so good. But who knows the future…..
Question for Susan Hermann: if you read/see this. Did your husband have “Sudden Hearing Loss”? My husband had it, it came on very very quickly, and he too has total and complete hearing loss in that one ear. We too did not get the steroids soon enough… and this was in the U.S.
Lynn, this is a wonderful post and has given all of us a lot of food for thought.Health care (and the right to have it) goes back even to Aristotle (including the paper he wrote about it).Such a really important(and worrisome) issue,one affecting each of us, especially in our older years and because we do not all live in one place. I wish there were simple solutions.
The French system has my admiration.
The Time article you shared is beyond thought provoking.
Thank you for sharing it with us.
I live under the second best health system in the world: Italy. I pay 7.5% of world income for complete coverage. I have had MRIs, prescriptions, surgery and many specialist visits and I am satisfied to understate a bit. It’s such a relief not to worry that as I grow older I can’t lose my home or my savings to a disease.
One of the best things about the system is that everybody gets treated. We are experiencing a severe recession and unemployment is high. A co-pay of a few euro has been put in place for higher income subscribers to help pay for the unemployed and the helpless as those numbers grew. It’s not particularly fancy, but in my region it is very good. Some of the avant garde advances in medicine are coming out of Italy, for example, artificial cartilage and electronic re-rythmn of hearts, which can avoid the use of pacemakers.
I would feel ashamed of getting great health care if others were denied it. I agree with Italians that health care is a right. Although employers collect the 7.5% tax for insurance, you don’t have to have a job to be covered. A neighbor who farms pays for his just as I pay for mine. If you are unemployed or very poor, you apply for a card that gets you the same treatment I get for nothing until you get a job. Private insurance is available for those who prefer not to be in the state system, but if you have a job you will be assessed. Insurance is naturally less expensive here, because the charges are so much lower, with most office visits from 30-50 euro. A friend was hospitalized with peritonitis for 10 days and his bill was 1200 euro all-inclusive. They take Master Charge!
I don’t think I could afford to live in the USA. My monthly insurance payment 13 years ago without drug coverage was almost what my annual payment is here.
We are Americans with Irish passports too. We moved to France 7 years ago for my husband’s job and immediately applied for a Carte Vitale. No problem. It was the quickest thing you ever saw. Now my husband is retired and we still have our Cartes Vitales. We pay 20 euros to go to our doctor but a portion is refunded through our French secondary insurance. When we go to the pharmacy we pay nothing. By contrast last time we visited the U.S. I dropped off a prescription for Janumet (I’m diabetic). The pharmacist said it would cost $1200 to fill the prescription!!! This time, I brought enough medication from France to last 6 months. So which system would YOU vote for???
People from all over the world still come to the U.S. for surgery and care for extreme medical conditions.