After almost 4 years of living in France and experiencing French healthcare first-hand — as well as seeing the experiences of those around me — I’ve concluded that many aspects of the country’s medical system here are superior to healthcare in the US. In my experience, doctors have been patient, kind and thorough overall. Quality of care is subjective and largely depends on the doctor — I’ve experienced both sides of the coin. I’ve had great and horrible care in the USA and in France, but overall I’m extremely happy with the French healthcare system, but that’s not to say it’s perfect…. not by a long shot.
I am often asked what I think of French healthcare. People are genuinely curious about what my experience has been like. Other times people make comments praising French healthcare or ripping it a new one, but they’re sometimes misinformed.
So to clear up the myths floating around about the French healthcare system, I invite you to READ ON…
French healthcare myths
Let me kick this off by saying my thoughts here on the French medical system are based on my own personal experiences. I don’t claim to know everything (far from it!). Also, healthcare is a complicated and emotional topic so please keep your comments respectful if you choose to leave one below. You can read more about how healthcare works in France here (in French).
First, to give you some background, the French medical system is a universal service comprised of a network of public and private hospitals, doctors and other medical service providers. When you go to the doctor in France, payment is expected at the point of service and people in need of healthcare are not turned away due to age, employment status or pre-existing conditions. David Lebovitz has a nice post linked here about French healthcare for travelers, so check it out.
OK, onward and forward…
Myths about the French healthcare system:
Myth: That everyone gets coverage.
Only French citizens and legal French residents are covered by the French healthcare system — basically those that are paying into the system. If you’re visiting France as a tourist from the USA and break your leg, you will absolutely be treated, no questions asked, but you’ll be responsible for all costs. In many cases your American insurer will cover the cost but sometimes they won’t. Granted, the costs are much less than you’d pay in the US but they’re still your responsibility.
One fantastic thing I want to point out is that if you lose your job, you don’t lose your health insurance in France. Many times in the USA, if you lose your job, you lose your (and your family’s) health insurance along with your paycheck. The French system is independent of one’s employment status — and doesn’t discriminate based on age, wealth or your social class — so even if you’re unemployed, you don’t have to worry about bankrupting your family if you need surgery or another costly medical procedure.
For anyone who gets anxiety thinking about healthcare or has ever struggled with coverage, the fact that your job doesn’t factor in to you and your family’s health plan is a major plus. From a human rights perspective, this is the way to go. “Access to health care appears to have produced a healthier nation,” writes the WSJ. “France’s infant death rate is 3.9 per 1,000 live births, compared with seven per 1,000 in the U.S. The country has more hospital beds and doctors per capita than the U.S., and a markedly lower rate of mortality from respiratory disease. And France spends less (10.7% of gross domestic product) on health care than the U.S. (16% of GDP).” France’s system is not without fault though.
Myth: That it’s free (or really cheap).
This one grinds my gears! I just heard it last week from a healthcare professional in the USA and it might be one of the most widely believed myths about French healthcare! Compared to the cost of care in the USA, French healthcare costs are without a doubt more affordable. But free or really cheap? No. Let’s not forget that the French pay heavy social charges (plus income tax, real estate tax, TV tax that further diminish take home pay) — they pay into the system, along with employers on the back end. So even though the flat fee of 23 euros is cheap for a general doctor’s visit (and most of that is reimbursed by the social security system, and even more if you pay for supplementary insurance) the French do pay a hefty sum for their healthcare but it’s not when services are rendered. Every paycheck you get shows the deductions for social charges (including healthcare) and you pay into the system whether you’re sick or not.
Beyond paying into the system, French health services are not always low cost.
Many seemingly regular medicines, tests and services are NOT covered and have to be paid out of pocket.
To give you some context, a French family member had a colonoscopy recently and the procedure itself was covered but the anesthesia was not. Most people opt for anesthesia and end up paying out of pocket for their comfort. Some of these charges are reimbursed by the patient’s mutuelle (supplementary insurance most French people pay for to pick up the difference between what’s reimbursed and the full cost of the service). Birth control pills are also not covered and you pay the cost (cheaper than the US though) out of pocket. Same with any specialized blood testing for allergies, etc. Case in point? A family member’s gluten sensitivity blood test — 90 euros out of pocket, 0 reimbursed. If you’re dying of cancer, you’ll be taken care of but if you have a chronic, non-life threatening illness or something that requires specialists who order out-of-the-ordinary tests, or alternative providers in general, get ready to cough up the cash. That said, medical bankruptcies don’t exist in France so even if you are paying out of pocket, you won’t lose your house.
Myth: That the healthcare is great.
That’s a really loaded statement. “Great” is subjective and wholly depends on the facility, doctor and your ailment. There are great and not-so-great practitioners everywhere in the world. Let’s not fall for the grass is always greener syndrome. What does “great” mean to you? I may be biased but I firmly believe that French healthcare is great for emergency and routine coverage. If you need emergency surgery or have aggressive cancer, the French system has you covered, as noted above. Along with that, if you’re reasonably healthy and see the doctor once a year and rarely need specialists, the French system is great as well. But if you need to see specialists regularly, they’re often difficult to book an appointment with due to overcrowding (6-month wait for new patients was the case for me at the dentist and dermatologist) and if you do get in, the doctor may be rushed.
To be fair, this is often the case in the US too. My dermatologist in New Jersey was impossible to get an appointment with and when you did get in, she spent a rushed 5 minutes with you. And billed the insurance obscene amounts. Does this happen in France? Sure (not the obscene amounts part though). But I have to say that I’ve also spent 45 minutes with my doctor who was patient and thorough. Although now he has too many patients and is often rushed.
Myth: That it’s easy to see specialists.
Unlike general practitioners, specialists are allowed to set their own rates beyond the standard rate and only a portion of whatever the government deems a reasonable charge is reimbursed. So if the regular cost to see a dermatologist is 45 euros but yours charges 70 euros because he’s in demand, you’re only reimbursed a portion of that baseline charge of 45, not the entire 70. As noted above, it’s sometimes very difficult to get in to see a specialist if you’re new to an area and/or your condition is annoying but not urgent. You’re going to wait. Many times you’ll need a referral from your GP to see a specialist in a timely manner and to be reimbursed. Lesson here? It’s best to learn how to finesse people over the phone sooner than later. Sometimes when the gatekeepers pity you, they’ll be more likely to help — that goes double if you’re being polite.
There are pros and cons to everything in life and the French healthcare system is no exception. The next time you hear someone talking about French healthcare, perk your ears up and see if they know fact from fiction!
How’s your experience been with French healthcare?