'French healthcare is baffling and complex... but it works'

I know what I am about to say depends on who you are, where you are and your circumstances, but I would like to put forward the proposition that healthcare in this country is pretty good, all things considered. 

That is not to say it is without its disadvantages, and we have to be honest about these.

Healthcare here is a rather baffling combination of public and private elements. A few procedures are free at the point of service but mostly you settle your bill directly with the doctor or his/her secretary and claim the money back afterwards. 

To begin with, this arrangement seemed transactional and materialistic to me, but now I barely think about it.

The other defining characteristic of the health system, such as it is, is the carte Vitale. This entitles you to a reimbursement of a large percentage, or at the very least some, of your expenses. 

For most users, then, healthcare is not entirely free and an element of inequality creeps in. Anyone who is not fully covered can pay for a mutuelle to make up some or most of the difference in the doctor’s bill, but this can be an expensive monthly item to keep up. 

Some mutuelles are more generous than others, but shopping around for the best deal corresponding to your age and employment status is a time-consuming business.

How does your area of France fare for delay to see a doctor?

The other big downside of the health system is human geography. Medical practitioners are mostly free to follow market demand and this means they live where they want. As an expert once told me, if you want the best choice of healthcare, buy a house in a lively city with a low crime rate, or by the seaside. 

Another way to look at this is that where an area is under-provided for by a particular specialty, a doctor can forget about patients who need to be reimbursed and go entirely private. 

There is an ophthalmologist near here who charges top rates because he knows the only alternative is to queue for the best part of a year for the oversubscribed service at the public hospital.

There is, however, one great advantage of the public-private system, and that is that you, as a patient, are free to shop around. You can choose your own specialist according to a friend’s recommendation and decide where you have your operation done. 

Read more: What essential health screenings are available for free in France?

Those in the know may well tell you to avoid a certain hospital and apply to one higher up the league tables.

Obviously, this freedom of choice depends on waiting lists and having your own transport, but even this is catered for to some extent. Where I live there is a family-run medical taxi and VSL (véhicule sanitaire léger) service, most of the fares being reimbursed by the state. 

Seven French expressions revolving around health

In any country, healthcare is expensive to fund and the French got used to the formula of paying higher taxes for getting back exactly what they wanted.

For years they enjoyed the reputation of being the country in which anyone could afford to be a hypochondriac. 

Now, things are tight. Every year, there are hot political debates about how state funding for healthcare is handed out, or an announcement that some particular dental procedure has been declared elective and will no longer be reimbursed. 

Does the system work? It can, if you know how to play it, you are lucky with where you live, and can afford to run a car. 

I have a friend who had her hip done in one city; her eyes checked in another; and she now goes to a knee specialist in yet another location. 

Perhaps the lesson is: keep informed and keep a little money aside to oil the wheels of a machine that works, with exceptions, reasonably well.

Do you agree with Nick Inman? What has your experience been with the French healthcare system? Let us know via letters@connexionfrance.com