Overview
The French health care system is one of universal health care largely financed by government national health insurance (Assurance Maladie). Most general physicians are in private practice but draw their income from the public insurance funds. The French government generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals.
What happens if you need to see a doctor?
In theory, if you need to see a specialist, then you need to go to your GP and ask him or her to refer you to the appropriate doctor. But in practice, you can just make an appointment with any doctor directly and Assurance Maladie will cover the corresponding costs, even though you did not abide by the rules. More and more people struggle to have access to specialists because the number of people who can study medicine is strictly limited and doctors can open their practice wherever they want once they graduate. This means that some areas lack doctors, especially in certain fields (ophtalmology, gynecology). Also, Assurance Maladie does pay for part of the costs when you go to see a doctor, but there is a standard price and doctors can actually ask for more than what is covered. In this case, you need to pay extra (although your private health insurance might step in at that point if you have it).
Who decides what doctors can prescribe?
The ANSM or French national Agency for Medicines and Health Products Safety, is the country’s regulator. Doctors can prescribe what they want among what is agreed by the Assurance Maladie (our National Health) and approved by ANSM.
Practically, what is it like to live with type 1 diabetes in France?
The French system is sometimes presented as a paradise. We pay according to what we earn, and we get according to what we need.
Type 1 diabetics and most type 2 are considered having what we call “Affection de Longue Durée” (ALD, long term disease), which means that everything prescribed linked to our illness is reimbursed at 100%. This measure, which was initially conceived for people with sclerosis, cancer or diabetes is now applicable to 20% of the population, and it’s one of the main causes four our national health financial disaster. While it is free for most people because it is covered by the government, the actual cost of insulin, lancets, and test strips is so huge that people who happen to be out of the health system, including students having a gap of coverage, can’t afford the treatments.
Awareness about our disease is quite low in France. Most people simply do not know there are several types of diabetes and, obviously, only know about type 2. I would say half of the GPs I have met believe insulin pumps are artificial pancreases that inject insulin automatically depending on blood glucose levels. Other people struggle to understand how crude the treatment actually is and are convinced absolutely huge progress has been made in the last few years, so that “diabetes” is actually no problem at all anymore, which is not true.
What about getting admitted to hospital?
After you have been in hospital, you receive an invoice at home that you can pay online or by cash or check. The amount of the invoice varies depending on your health coverage. Sometimes you actually do not need to pay anything (pregnant women after the 6th month, people who benefit from government schemes like CMU or AME, etc.). Sometimes you only pay for what Assurance Maladie does not cover. In the worst cases, if you have dropped out of the health system altogether you must pay for the whole cost and it is dreadfully expensive. In most cases what you need to pay is a very small fraction of the actual cost. After you have paid the invoice, you can also ask your Mutuelle (private health insurance) to refund part of it. For most people, going to a public hospital is not expensive, especially if you think about the actual cost of the treatments you receive there compared to what you have to pay.
How does diabetes care vary throughout France?
It’s pretty the same everywhere in the country. There are diabetes services in the big cities but there aren’t as much, if any, in rural areas. In some regions most diabetics have insulin pumps and not in other regions. It depends on the commercial strength of the manufacturers, who may have had more success to place their products in some areas. Also the two main diabetics associations, the AFD and the AJD for children, are financed by the industry and the government, so it’s impossible for them to speak freely about the cost or availability.
We are grateful to Frédérique Georges-Pichot and Bertrand Burgalat for helping with this information for France.
Last updated 2016
