Being sick in France (#1)

If you have a problem, you need to go see a doctor, go to the hospital or go to the next-door pharmacy. Do not panic ! France has good doctors and a very good Social Security system ! Read Harriet's column about healthcare in France and discover some comparative Facts and Figures..

French "Social Security" made simple		Where to go ....
As a matter of principle, everyone working in France must contribute to the French Social Security system and everyone (French or not, working or not, unemployed, child or retired, legal or illegal immigrant) is entitled to benefit from it. There are few (recent) exceptions to this principle but it is maintained (with CMU : Couverture Maladie Universelle which means "health plan for everybody" only 0,1% are not covered). The system is rather complex and considered bureaucratic when it comes to create a new company (but not for the patients). The system is threefold : Health, Family and Retirement, each of them has different structures and financing ; each of them is financially autonomous (no taxpayer's money - except to subsidize CMU- but contributions by employers and employees to make it balanced) : to understand it better : see the anatomy of a paycheck ; The Health system (Assurance Maladie) is based on the concept of providing a large amount of help for any medical need, and total help when it is serious : on the basis of a standard cost, medical care (doctors appointments and visits, dental care, etc..) is reimbursed around 80%, medicine from 80% when corresponding to a real medical need to 40% for less needed and of course 0% for others ; standard cost for a doctor is 22 Euros (sometimes, they can charge 30 Euros or more: dépassement d'honoraires) ; serious illnesses, including those due to old age, are covered 100%. Practically speaking each person has a chip card (Carte Vitale) which is read by the doctor's or pharmacist's terminal and a 13-digit "numéro de Sécurité Sociale". The health system is a key-element of the French national identity : the "three best symbols of the French nation" are the flag, the health system and the Marseillaise (source : survey TNS-Sofres March 2005) Contrary to what one could expect from a large, state-owned and centralized organization, the system is very efficient : the administrative cost of the health system is around 4,5% (for US private insurance companies : 10 to 13%) and 1,2% for the retirement system (vs. around 10% for most pension funds). The health system reimburses very quickly (after four days). The Social Security structure is managed on a paritary basis : each regional organization (Caisse) is managed by a board composed 50/50 of representatives of labor unions on one side, employers associations on the other side, with the State playing the role of a referee ; the financial contribution of the patient is very limited and most of the funding is public. The state is considered responsible of its good functioning, but it is not accurate to call it a "socialized system". See why. The Family system (Allocations Familiales) is a financial help to all families (whatever their income) plus various services such as day-care or vacation centers (according to income) ; when a family is expecting a child, it gets approximately 2,000 Euros in three installments (the first two of them corresponding to a mandatory medical visit, the third to the birth) ; then the family receives a monthly allowance till the child is 20 (for two children or more, around 100 Euros/month/child) : see detailed numbers ;this is not the only allocation and this organization ("Caisse d'Allocations Familiales") yearly distributes enormous allocations (Euros 72 billion in 2009) to millions of families : for families of two children or more, to help people to keep their old parents in their home, for children with a handicap, and many others… (See details) The Retirement system (Assurance Vieillesse) provides a minimal pension (in the range of 750 Euros/month) to any person who has worked 40 years : click here for more		Basic tips for tourists you can see any doctor (they also make house calls for a small supplement) for a cost of around 23 Euros ($ 30) but you will not be reimbursed by Social Security if you are not part of the French Social Security system you can be treated by any French hospital in case of emergency (they will talk about money AFTER treating you...) you can buy certain drugs over the counter in a pharmacy but a lot of them require a doctor's prescription ; don't be surprised if you do not find US drug brand names, you are in another country ! If your French isn't good, there are two hospitals with English-speaking staff : the American Hospital, 63 blvd Victor Hugo 92202 Neuilly, Tel. 33-(0)1 46 41 25 25 ; Email : patient@ahp-paris.com the British Hospital, 3 rue Barbès 92300 Levallois Tel. 33-(0)1 46 39 22 22 Public or private ? For a serious case, it is often wiser to go to a public hospital, especially a CHU (Centre Hospitalo-Universitaire). In case of a (real) emergency call SAMU (this is a day and night emergency service tel. 15) or les pompiers (fire-brigade) who provide 24 hour-emergency service (tel. 18). Useful numbers for emergencies (other than 15) : Urgences pédiatrie (pediatrician emergency service) tel. 01 43 94 35 01 SOS Medecin tel. 01 47 07 77 77 : very reasonably priced (around 70 Euros) and efficient, a doctor in your house in less than an hour SOS Dentiste tel. 01 43 37 51 00 SOS Help (English-language crisis line) tel. 01 46 21 46 46 Pharmacie des Champs Elysées (24 hours a day, English-speaking) 84 av. des Champs Elysées 75008 Tel. (0)1 45 62 02 41 DID YOU KNOW THAT ... In France everyone is entitled to minimum health coverage paid by the State, even the poorest and homeless, even illegal migrants (Couverture Maladie Universelle, CMU). For illegal immigrants (who are in France for more than 3 months) and their family, the AME (Assistance Médicale d'Etat) provides free healthcare at taxpayer's expense (540 m. Euros in 2010) : doctors and hospitals treat people, are paid by the State Administration and do not have to give people's names. It is more important to keep people in good health than to fight illegal immigration : as a Frenchman, I must admit that I am rather proud of that ! In Nov. 2010, a few limitations were decided (a 30 Euros flat fee and the the exclusion of non vital treatments like plastic surgery) and it was considered very tough.... DID YOU KNOW THAT.....? Health coverage by Social Security ("Sécurité Sociale") is mandatory and paid both by the employee (1/4) and the employer (3/4). You can choose any doctor or any hospital. The French, whatever their political opinion, cannot believe when they are told that millions of Americans do not have any health coverage. Click here to know more. The World Health Organization (WHO) has ranked the health system of its 191 member countries and France tops the list for providing the best overall health care (UK ranks 18 and USA ranks 37) (source : International Herald Tribune June 21,2000). I am often asked the question : "is there anything in France which is better than in the USA ?" and, in my opinion, the Health System is among the 4 fields that could compete.... See about it and the three others.... Michael Moore's movie "Sicko" (2007) gives a good idea of the French system, as opposed to the American system.
Any system offered by a company to its staff is in addition to these national systems and health insurance and retirement pension NEVER depend on the financial situation or even the survival of your employer(s) or former employer(s). For the French, it is just unthinkable that, if you lose your job, you also lose your health plan : those two hazards must not be linked. This is a typical example of what the French call their "social model" and one of the few where, in my opinion, the USA could learn something from the French experience. Read my opinion about it "Socialized medicine : give me a break" or "the best place to be sick is France!". Main amendments to the system as of Jan. 1, 2005 : You have to pay ONE Euro more (not reimbursable) for every visit to the doctor (many people say that asking for such a huge financial effort from the patients is a shame ! ! !) before you see a specialist (except for gynecologists, ophtalmologists and psychiatrists), you must see a GP first (otherwise, you'll be reimbursed a little less) For more information, read AAWE and for Expats, check with your company and contact associations such as AARO , visit the official site of French Social Security (in French) or read a column in the International Herald Tribune ("French Lesson", 14/8/2007). If you have a specific question (for instance : what if I retire in France ? I worked in France ninety five years age, do I qualify for SS ? etc...), please do not ask me ! This is a rather complicated field and only CPAM (health coverage) or CNAV (retirement) can answer you. HOW TO READ A "NUMERO DE SECURITE SOCIALE" ? The ten first digits mean something : first digit : 1=male, 2=female, then XX=year of birth, XX=month of birth, XX="département" of birth (99 for outside France), XXX=code of the city in the "département", XXX=number. The "numéro de SS" is used for many official purposes.		Name of useful medicine ... Here is a list of common medicine you can buy without a prescription in any French pharmacy : Diarrhea : IMMOSEL, SEPTIDIARYL, ... Headache : ASPIRINE, DOLIPRANE,... Tonsilitis : ANGISTRAY, ... Hemorroïds : PREPARATION H, ... Bruise : ARNICAN, ... Acid indigestion (this illness is hardly known in France) : MAALOX, GELUSIL, PEPSIDAC, ... Troubles associated with periods : MIGRALGINE, ... Sore-throat : COLLUSTAN, STREPSIL, SOLUTHRYCINE, ... Common cold (runny nose) : FERVEX, RHINOFEBRAL,... Insomnia : DONANMYL, ... and : If you are allergic to something, read my column about "the ugly American eater" If you feel tired, try thalassotherapy In case of sadness and/or if you're homesick : use Red Wine! USEFUL TIPS.....In France, pharmacists have the right to give medical advice. Rather than go to the doctor when not seriously ill, many people prefer to consult the pharmacist for what medicine to take. They are generally very helpful . Try to avoid the word "allergy", unless it is a medical fact : the French do not take it very seriously....
Health care in France		For expats (section to be developped)
Preventive medecine : Medecine du travail (labor medicine) : all companies, whatever their size, must provide their staff with an annual visit to a doctor ; in big companies it is a in-house doctor, in small companies an external doctor who comes for the annual controls. All expenses are paid by the company and of course the employee does not pay a cent. The 20-minute visit includes whatever check-up seems appropriate (heart, eyes, stress, depression...). The doctor cannot prescribe medecine but can prescribe a visit to the doctor is something new that is wrong or needs a more thorough check is detected. For preventable mortality, a scorecard by the Commonwealth Fund (IHT July 17, 2008) ranks France first (followed by Japan and Australia) and the USA last (after Ireland and Portugal). Sick leaves : the law is that up to 20 days, the Securité Sociale reimburses the salary to the employee with two limitations : not the first 3 days and up to a maximum ("plafond"). Most companies have additional agreements to eliminate these two limits and, in fact, for almost everybody, it does not cost anything to report sick. Sick leaves represent, on average, 14.5 days per year per employee : less in Paris (10 days) than in the South (26 days), less in construction (11.8) or commerce (13.6), more in industry (14.4), services (16.1) or the health sector (21.3). Quite expectedly, people call in sick on Friday (54%) or Monday (32%) more than on the other days. Many companies or administrations have created a special incentive for people who are never or rarely sick ("prime de présenteisme"). (Source : Le Point 31/5/2012) French doctors are not very different from American doctors, except they make much less money (three or four times?) and are probably much more accessible, less protected by a dragon-secretary. The French Health system is efficient and affordable : I consider it one of the few fields in which France can be proud of herself when comparing with other countries. See the (very) few other fields of French excellence (no : it is NOT food and fashion...). And the French live older than the Americans ! Click here for a comparison of a few ratios between France and the USA. Forget your prejudices about what so many people call "socialized medicine" without knowing what it is : look at the facts ! In France you can choose freely your doctor and he/she is free of his/her prescription : you are not treated by the governement ! Read my editorial about it. Quite unexpectedly for a nation where people always complain, the French are rather satisfied with their health system. According to a 2010 international poll, 61% of the French consider the organization of their health system good to excellent (against 44% for Americans) and 82% would not go anywhere else, even for cheaper. The most satisfied are the Austrians, the least are the Poles. See detailed figures. Read my (chauvinistic) point of view about the French Health system . Click here to read Harriet's column about Health in the Paris Pages (July 2000). Some people disagree with this viewpoint : see a letter from Anne. For expats, AARO (see American Associations) provides health insurance for its members. DID YOU KNOW THAT....? In France, the maternity leave is 16 weeks minimum (of course paid 100% of the salary!), plus one month minimum if the baby is breast-fed ; "paternity" leave is two weeks ; new mothers spend 3 to 6 days in the hospital.		A good site dedicated to expats gives a lot of information. USEFUL TIPS..... Many Americans, who do not speak French and/or do not trust French doctors, try to find a " quasi-American " doctor. There are a few doctors who work a lot or only for the American community. They are not any better or worse than others but some of them have figured out that Americans generally do not know the French health system and can be charged any price : they take advantage of it. Most French people are horrified about that! DID YOU KNOW THAT .... ? The very concept of medical emergency is not seen the same way in France and in the USA. In the USA the Emergency staff is a driver whose job is to take you as fast as possible to the hospital, whatever your condition, in a fast ambulance. In France, the SAMU team includes a MD whose job is to do as much as he can before taking you to the hospital in a more heavily-equipped ambulance. Both ways have their pros and cons, but dont be horrified if you see an ambulance NOT moving.... USEFUL TIPS...Do not panic if a doctor asks you to undress completely with no nurse around. Unlike the U.S.A., there is no regulation requiring the presence of a woman nurse with a male doctor or vice versa. USEFUL TIPS.. If you have a sore-throat and the pharmacist prescribes suppositories, don't be surprised : it is a traditional (and quite effective) treatment! DID YOU KNOW THAT .....? The French often mention a disease which does not exist elsewhere: the "crise de foie" (literally : liver crisis). The "crise de foie" covers a wide range of illnesses from hang-overs to diarrhea, but the liver has nothing to do with it. On the other hand, if you literally translate "stomach ache" to a French doctor, he will look at your stomach whereas it is your intestine which is in trouble.... In French "mal au rein" (literally : kidney ache) means backache and "mal au coeur" (literally : aching heart) means being nauseated.
To related pages : a column of the Health system (#2), an American article on the French health system (#3), etc....

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Harriet Welty Rochefort writes articles and books about France and the French. Order her books : "Joie de Vivre", Secrets of Wining, Dining and Romancing like the French, St.Martin's Press, New York, 2012 "French Toast, An American in Paris Celebrates The Maddening Mysteries of the French", St.Martin's Press, New York, 1999 "French Fried, The Culinary Capers of An American in Paris", St.Martin's Press, New York, 2001 More on Harriet's books (excerpts, upcoming events, testimonials, etc..)

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