Health Care in France
Anne-Marie Simons, Aix-en-Provence, France
Before you decide to settle in a foreign country for your retirement, you tend to think about “old age issues” and how they might compare to the United States. One of those would be health care, another one might be inheritance tax or estate planning. Not being an expert at the latter I will stick to French healthcare which I know from experience and have come to appreciate and admire.
My husband and I left Washington, DC, in 1998 to settle in Aix-en-Provence. Though it was a bit of a stab in the dark, a “let’s see what it’s like” kind of decision, we have not regretted it for one minute. I need not tell you about the known pleasures of the area—good climate, daily markets, proximity to the Mediterranean, culture and natural beauty all around—but a few early surprises bear pointing out.
The first one was our car accident which occurred only a few weeks after we had bought our bright and shiny new Peugeot. In a slight curve a distracted driver ran into us with enough force to do major damage to the two doors on the driver’s side. He jumped out, apologizing and admitting right away that he was at fault, but I instinctively flagged down a passing gendarme thinking he would draw up an accident report for insurance purposes. When he saw that no one was hurt, however, he climbed back on his bike to let us settle the matter between ourselves. Here, it turns out, when there is only material damage the two drivers fill in an accident report (to be carried in all cars) and sign it. The insurance companies do the rest and there is no need for lawyers. Of course, there are no frivolous lawsuits either and no getting rich on a whiplash.
In the same vein, we found an amazingly good and generous healthcare system here. The French are covered by a national health system called la Sécurité Sociale (Sécu) which requires a modest co-payment from the patient but is heavily subsidized by the government and is available to all. A mutuelle provides additional coverage to those who wish to buy it. There are no exclusions for pre-existing conditions. All patients are required to have a general physician or family doctor (comparable to our internists) who will refer you to a specialist when needed. The government regulates doctors’ fees.
As foreign residents in France with American health coverage we are not part of the Sécu but we do enjoy the same government-controlled low fees as the locals. We simply get reimbursed differently. And the same excellent services are available to us, be it doctors’ house calls, post-operative at-home nursing care, or physical therapy. We pay 23 euros to see a doctor at his office, and 32 euros for the doctor to make a house call. In spite of city traffic and parking problems, doctors continue to pay house calls here and if they are unable to do so themselves they will ensure that a colleague stops by. I believe that France is among the few Western nations, if not the only one, to still do so.
Another pleasant surprise was the price of prescription medicine which is often so low that we do not bother sending in a claim for partial reimbursement. Not so long ago, everything at the pharmacy was reimbursed by the Sécu, even band aids, aspirin, vitamins, support hose - as long as the doctor had prescribed it. With the mounting Sécu deficit, however, this had to change and today only prescription drugs are fully reimbursed. Even so, the deficit is getting alarmingly big and rumors of further cutbacks (to a chorus of howls and protests) are being heard. Nevertheless, as a former American I can categorically state that living in France has taken all the anguish out of getting sick, no matter what insurance you have.
The public hospitals (government financed and price-controlled) tend to be very well equipped and practice the latest techniques. Case in point: It was in one such hospital (Hôpital Nord, Marseille) that my husband was operated on an aneurism of the abdominal aorta (AAA) with a technique called laparoscopy performed by the head of the department of vascular surgery. Because of the very sophisticated equipment and the need for specially-trained surgeons, this is an expensive operation but to our amazement the bill for the surgery was about $2,500 and the one-week hospitalization (including 48 hours in intensive care) came to about $2,000. The Sécu bill would have been even lower, but these were charges to a private patient! The cost of post-operative nursing visits at home was negligible and the first year of check-ups with the surgeon was free.
When we visit our children in the Washington area once a year, my husband continues to see his American internist who was most impressed with the medical file and the very small scars of this laparoscopic surgery. “You would not have had this operation here,” he explained, “because American insurers consider this experimental surgery and won’t pay for it.” Yet, in France laparoscopy has been done for over 10 years and the government-controlled cost simply eliminates the money-question from the equation.
When I sense a certain reluctance among Americans about medicine abroad, I know that they are misinformed, at least as far as France is concerned. The term “socialized medicine” spooks them and evokes totally unfounded fears. “You cannot choose your own doctor” is one of the misconceptions. Ask yourself where that information came from and you may find the AMA lobby lurking in the background. Why do we accept rent control in America but object to fee control? What is so objectionable about “subsidizing” healthcare to make it available to everyone? Wouldn’t you rather see your tax dollars spent there than in […..]? Fill in the peeve of your choice.
Let’s say that fear of the unknown health system should not stop anyone from moving to France. You will be in for a very pleasant surprise, and with the money you save on health expenses you can afford to live a life of good food and good wine any day of the week. It’s good for your mood and it’s good for your health. Santé!
Anne-Marie Simons is the author of Ten Years in Provence