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A guide to the French healthcare system

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A guide to accessing the French healthcare system, including finding a doctor or specialist, going to the hospital, dentists and emergency services. Healthcare in France also requires mandatory health insurance.

The French healthcare system covers both public and private hospitals, doctors and other medical specialists who provide French healthcare to every resident in France regardless of age, income or status. This makes the French health caresystem highly accessible, even for foreigners.

Additionally, the majority of French healthcare costs are covered by the state via a public French healthcare insurance scheme. It is compulsory for residents in France to register with a French health insurer, as well as register with a doctor in France and go through this doctor for most treatments in order to be properly reimbursed by the French healthcare system.

This guide explains everything you need to know about accessing the French healthcare system:

French healthcare system updates 2016-2017

As of 2016, a new French healthcare system for foreigners known as the Protection Universelle Maladie (PUMA) allows all residents in France - working or not - to have access to French healthcare after three months of residence.

By the end of 2017, doctors and certain medical personnel will not be allowed to charge upfront payments - essentially meaning 'free' doctor visits - but instead will be paid directly by the government or health insurer, unlike now where patients typically pay cash upfront and claim a reimbursement later.

In 2017 a new phone line (116 117) will be introduced to help you find the closest out-of-hours doctors.

The French healthcare system: how it works

The healthcare system in France is funded partially by obligatory social security contributions ( sécurité sociale), which are usually deducted from your salary. In 2016 employees paid around 8 percent in total, while employers paid around 13 percent of salary towards health costs. The French healthcare system is also partially funded by the government and the patient, too, pays a small contribution to their healthcare costs.

In 2016, the French government implemented a new French healthcare system for foreigners known as the Protection Universelle Maladie ( PUMA), replacing the previous Couverture Maladie Universelle ( CMU) system. The reform is aimed at simplifying the French healthcare system and reducing paperwork, as well as guarantees that everyone who works or lives permanently in France (longer than three months) will have access to French healthcare and reimbursements. In addition, starting at the end of 2017, doctors and certain medical personnel will have to waive upfront payments and be paid directly by the government or health insurer, unlike the system now where some patients pay upfront for their French healthcare services and make a claim later.

When you see a doctor or have medical treatment a percentage of the cost - usually about 70 percent of doctors' fees and 80 percent of hospital costs - will be reimbursed for most people through the French healthcare system, so long as you are referred by your 'attending doctor' (see below). In the case of some major or long-term illnesses, 100 per cent of the costs are covered.

The remainder of your charge must be paid for either by the patient or through any supplementary private health insurance. This is why many people take out top-up health insurance (l'assurance complémentaire santé) often organised by a 'mutual society' ( mutelle), or insurance provider. When you take out one of these policies, note that some may not cover certain sports and they may not offer immediate cover either. There are also other small charges that must be paid for by the patient, for example, a EUR 1 out-of-pocket charge per GP visit.

The French healthcare system is considered among the top healthcare systems in Europe, scoring well for the abundance of doctors, low waiting times and good healthcare spending, although French doctors tend to medicalise many conditions and hand out lots of drugs.

French healthcare system coverage for foreigners in France (PUMA)

By law all residents in France must have some form of health insurance, whether private or a state French health insurance scheme (read our guide to health insurance in France).

In order to be eligible for coverage under the state French health care system (PUMA), you need to be either employed or living in France on a stable and an ongoing basis for more than three months with the intention to spend more than 183 days a year in France. Previously you were also required to hold a valid French residence permit and pay French social security contributions via paid employment for a set period, which excluded certain categories of residents such as retirees and EU citizens that can now claim healthcare under PUMA.

Previously, you also had to change your French health insurance plan if there was any major change in employment or your household, which potentially led to a break in healthcare coverage, as well as typically apply for an annual renewal. Thus PUMA is also about improving continuity by eliminating the need for any administrative formalities when changes in circumstances occur.

You will typically need to pay cotisations sociales (social contributions) to cover your healthcare in France, although some categories are excluded, for example, if you earn below a certain threshold.

If your household income falls below a certain threshold (which depends on number of people in the household), you may also be eligible for free supplementary health insurance coverage (CMU-C) or for help in taking out a supplementary private heath insurance ( Aide pour une Complémentaire Santé or ACS). If you're living in France but your application for legal residence has not been finalised you may be eligible for State Medical Assistance ( Aide Médicale d'Etat or AME). For more detailed information, see the CMU website (in French with some English language pages).

If you are financially dependent, the system of ' ayant droits' was abolished with PUMA and instead all eligible persons are granted their own right to healthcare, significantly improving the situation for economically inactive spouses.

If you're self-employed, read our guide to taxes and social security for self-employed workers in France, or see the Regime Social des Indépendants (RSI) or URSSAF for information on registration, contributions and reimbursements. Self-employed workers and business owners typically get French healthcare cover from day one of starting their business. The process is not automatic, however, so you will need to follow each step of the process.

If you're not eligible for PUMA, you may have to take out private health insurance from a local or expat health insurance company. Some of the largest international health insurers include Bupa Global, Cigna Global and Globality Health.

How to register for French healthcare

If you have lived in France longer than three months (and applying under PUMA), you can register for French healthcare via your local CPAM (Caisse Primaire Assurance Maladie) office. You can find your local CPAM office via the Ameli website (in French).

If you are employed, your employer will first register you with French social security after which you can register for French healthcare. Your employer may arrange your healthcare registration but it's not a legal requirement, so make sure you chase the paperwork and check CPAM has been contacted. If you're self-employed, you need to contact the Regime Social des Indépendants (RSI) instead.

You'll need to show certain documents, which can include your passport or national ID card, proof of your long-term residence, marriage or birth certificates if family are to be included, evidence of income and proof of your address in France. You'll also need to choose a primary and submit a declaration ( Declaration de Médecin Traitant) to your insurer before accessing healthcare in France.

The CPAM office will handle your reimbursements, although it is the URSSAF which will handle your ' cotisations' (contributions) for access. You will typically need to pay around 8 percent of your income if you earn above a certain threshold (EUR 9,654 in 2016), otherwise it will be free under the CMU-C scheme (read more in our guide to French health insurance)

Your French healthcare system card: carte vitale

Everyone over the age of 16 resident in France needs to have a carte vitale. Once you are registered with the French health system you will be issued with yours. This is a green, plastic health insurance card bearing your photo and embedded with a chip containing your name, address, social security details and details about any exemptions for payments, but no medical information.

Your French healthcare card is not necessarily issued automatically; you can ask for it once you are registered with the healthcare system in France. It is advised to follow-up on the process, as getting your carte vitale can take some time - some people have waited more than a year - if your situation is complex or you don't have the right documents. For this reason, you should ask for an ' attestation de couverture sociale ' which proves you have access to healthcare in France until your card arrives.

You'll need to take your carte vitale with you to any French healthcare appointment - GP, specialist, hospital or even pharmacy - with a card reader. It allows you to be reimbursed directly from the health insurance fund for the consultation or treatment within a week, meaning you don't need to pay upfront.

French healthcare system for EU/EEA/Swiss citizens

European Health Insurance Card (EHIC)

If you have an European Health Insurance Card (EHIC) card issued by an EU-member state and you are in France on a holiday or other temporary visit - that is, you are not a resident nor working in France - you can use your EHIC to access state healthcare in France the same as anyone covered under the state French healthcare system. You don't have to be registered with a médecin traitant (see below) to get a referral to a specialist. If you're a resident in France, however, you have to register with the French social security system and health insurance to access the healthcare in France.

Retired EU citizens and form S1

To access French healthcare, retirees will need to ask for a social security S1 form from their home country and then complete Cerfa 60-3406 Declaration en vue de l'immatriculation d'un pensionné in France. You will typically need to show proof of your pension alongside a translated birth certificate, passport and proof of residence.

Early retirees can also access healthcare in France - under the PUMA scheme after three months of residence in France - although economically inactive early retirees may have more difficulty getting approval.

Up until April 2014, UK citizens under retirement age were able to access state healthcare in France for two and a half years using the S1 form but this is no longer available. If you already hold a S1 card you can use it until the cover it provides runs out; if you do not, you will have to take out private medical insurance until you reach retirement age when you can get a S1.

Under the new PUMA French healthcare system, dependent family members of foreigners with a S1 exemption certificate do not lose their S1 rights, as the new law excludes those connected to a foreign pension who also get health insurance cover through their home country. This means that S1 households do not have to pay contributions to the French health system nor pay French social security on their pension. Thus those who hold an S1 certificate of exemption will only be affiliated with PUMA for the purpose of administration.

If you receive a pension from France, you are entitled to claim healthcare in both France and your country of residence.

French healthcare system and free medical exams

France's healthcare system allows a number of free preventative medical examinations, which are tailored to each person according to age, gender, work and social risk factors and environment. The free medical exam can be performed every two years, from the age of five, and is completely covered by your French health insurance. You can call 05 8167 1144 or fill out an online form to make an appointment.

Going to the doctor in France

The first line of healthcare in France is provided by family doctors or GPs ( médecins généralistes). These doctors are mostly self-employed and work either alone or in group practices. You are free to choose whichever French doctor you prefer, but you must register with them as your 'attending doctor' or primary doctor ( médecin traitant) in order to claim a full reimbursement via the French healthcare system. Read more in our guide on how to find a French doctor.

The médecin traitant can refer you onto other doctors and specialists, holds and maintains your medical records, and co-ordinates follow-up treatments. If you are referred by your médecin traitant around 70 percent of French healthcare costs, such as medical consultations or treatments, will be reimbursed. If you choose your own specialist then your medical fees may be higher and you'll be reimbursed much less by the healthcare system in France.

However, you don't need a referral to see a gynaecologist, paediatrician or ophthalmologist but can consult them directly. If you're under 26 you can also see a psychiatrist without a referral from your médecin traitant.

French healthcare prices are typically capped; a general doctor's appointment costs around EUR 23. See the government's list (in French) of doctors and clinics in France working within the state system.

Registering with a doctor in France

You can nominate any doctor to be your médecin traitant under the state French healthcare system. Both you and the doctor have to complete, sign and get the doctor's stamp on the Cerfa form Déclaration de Choix du Médecin Traitant and send it to your CPAM (Caisse d'Assurance Maladie) office.

You can change your médecin traitant at any time simply by completing another form and submitting that to the CPAM office.

Doctors' fees

When you visit a doctor in France, you will pay a fee upfront for the consultation, unless you present your carte vitale. Most doctors in France have signed contracts with the French heathcare system to provide medical services at nationally agreed rates and, by law, the doctor's fees must be posted on the surgery walls. These may vary according to whether it's an evening or weekend visit or a home visit. You'll be automatically reimbursed a percentage of the medical fee by the state-run health insurance provider, leaving a small amount of money payable by yourself.

The amount you'll be reimbursed depends on whether the doctor is in secteur 1 or secteur 2. Secteur 1 doctors' tariffs are fixed while secteur 2 doctors can charge what they want - yet patients will still be reimbursed a percentage of the standard rate. Some consultations are reimbursed 100 percent, for example, children's or expectant mothers' compulsory check ups, or if you're on CMU (Couverture Maladie Universelle or Universal Health Insurance Coverage) because of a very low income or serious illness. Read more in our guide to doctors in France.

Going to see a specialist in France

In the French healthcare system, specialists can work exclusively in their own practice, a group practice, in a clinic or a hospital or in a combination of settings. Some work in both the state and private sector.

Specialists charge higher fees than French doctors. There are official rates which have been set by the health service but some specialists can charge more, in which case the patient will either be reimbursed at the official rate or more if the health insurance provider has allowed for this.

Remember, under the French healthcare system you will only be reimbursed at the full rate if you have been referred to the specialist by your own French doctor. Of course, you can visit a specialist without a referral but the consultation will only be reimbursed at the basic doctor rate, regardless of how much the visit cost you.

French hospitals

There are two types of French hospitals: state-run hôpitaux and privately run cliniques, although cliniques are often state approved and work under the healthcare system in France. Your doctor can refer you to either a state hospital or private clinic. Around 80 percent of hospital charges are reimbursed by French healthcare but the 'board and lodging' costs of a hospital stay are not, which is where top-up insurance is useful. Read more in our guide to going to hospitals in France.

Pharmacies in France

You won't have problems finding a pharmacy (( pharmacie) in France seeing there are more than 20,000 pharmacies in the country, double the number found in the UK. It is perhaps not surprising considering France's 'pill-popping' reputation and the tendency of French doctors to prescribe many medicines. A report in 2013, for example, showed that one in three French used medication for depression, anxiety and other psychiatric disorders, which some experts say is a 'public health problem' while others say it just reflects the generous French healthcare system.

Prescription costs in France

Once you take your prescription to a pharmacy, a shop displaying a large green cross outside, you will be asked to pay a proportion of the cost of the medication, depending on the drug and your insurance cover; the French health care system pays the rest. The amount reimbursed varies according to the type of medicine and can be 15, 30, 65 and 100 percent.

Pharmacy opening hours

In larger towns and in shopping centres, pharmacies are usually open Mondays to Saturdays from 8.30am to 7.30pm, although in smaller towns they may close for lunch between 12pm and 2pm. One pharmacy in each area will open on Sundays and during out-of-hours. To find this duty pharmacy, look in the window of other pharmacies, in the local newspaper, call 3237 or look online.

Visiting the dentist in France

You are free to go to any dentist you like and don't have to go to the same person for all of your treatment. Most dentists work within the public French healthcare system, and costs are reimbursed in the same way as other medical treatment. You typically pay upfront and charges (or a percentage of them) are reimbursed later, unless the dentist can bill your insurer directly via your carte vitale. You should get a written quote before having any treatment.

Dental charges for most adults are reimbursed at 70 percent, while children's check ups at 100 percent. However, some procedures - orthodontics for example - are not covered under the state system and you will have to pay for this. You can search online to find a dentist in France.

Pregnancy and maternity in France

As soon as you suspect or know that you're pregnant, you should make an appointment with your doctor in France. Once the pregnancy is confirmed, the doctor will organise blood tests and take a medical history and issue a three-part document declaring the pregnancy ( déclaration de grossesse). You have up to the 14th week of pregnancy to send the declaration of pregnancy form to the Health Insurance Fund (Casse d'Assurance Maladie or CAM) and Family Allowance Fund (Caisse d'Allocations Familiales or CAF) in order to receive health benefits. For detailed information about all aspects of pregnancy and birth in France, see Expatica's guide to having a baby in France and French maternity leave.

French healthcare system pros and cons

Pros

French healthcare is inexpensive because of government-set fees and caps, besides the fact that the majority of costs are reimbursed. A doctor's appointment, even without reimbursement, can cost as low as EUR 23.

The public healthcare system in France is accessible to all legal residents in France, even those who are not employed.

Expats who are living France can access subsidised French healthcare after just three months of stable and ongoing residence, or sooner if they work in France and pay French social security.

French healthcare offers preventative care for everyone, including free full medical checkups every two years, making it easier for people to maintain better health and require less medical attention in the long term.

French healthcare allows patients the freedom to choose whichever doctor they want, and patients can also seek direct medical attention from specialists without a doctor's referral, unlike most healthcare systems, although reimbursement is less in these cases.

The quality of care provided by healthcare in France is topnotch and has consistently ranked to have some of the highest quality medical services in the world. In a 2014 Annual Global Retirement Index, the French healthcare system was ranked the world's best for retirees for being inexpensive, covering the bulk of expenses and having many English-speaking French doctors in the main cities. In the World Health Organisation's last report on world healthcare systems (2000), France was ranked as number one.

The French healthcare system has traditionally been known for its high use of prescription medicines, which some experts say is a 'health problem' in France.

As some foreigners cannot claim French healthcare until after three months of residence, they may be required to take out private health insurance to cover them in the interim.

The high quality of the French healthcare system comes with a price tag. Employed residents in France have to pay a considerable amount in taxes (social security) to shoulder the costs of healthcare in France. This is perhaps a burden to those who don't require as much medical attention as others.

Many patients still have to pay doctors and medical practitioners upfront for services rendered and claim a reimbursement later, although this is expected to be phased out by 2017 when bills will be charged directly to the French healthcare system. Some critics worry, however, that 'free' doctor visits could inundate France's medical services.

France is looking to create more safe injection centres, or 'shooting galleries', for drug addicts in order to reduce disease and overdoses, although this has been a highly controversial issue in France.

Facts about the French healthcare system

The World Health Organisation found that France provided 'the best overall healthcare' in the world in its latest global report (2000), with health outcomes ranked among the best in the European Union.

France spends around 11.5 percent of its GDP on healthcare, higher than the EU average.

The high quality of French healthcare and environmental factors have led to one of the highest life expectancies at birth in the world: 79 years old for males and 85 years old for females. This has continued to increase over recent years.

More than 75 percent of health expenditures in France are covered by government-funded agencies.

State reimbursements for the French health system vary from 70 percent to 100 percent of the full costs depending on the medical service used. Low-income and long-term sick patients receive 100 percent coverage.

In an emergency in France

In a medical emergency go the A&E or ER ( les urgences) of the nearest hospital. You can also call 112 (114 for hearing assisted), which is the free pan-European emergency number for any type of emergency, or one of the following numbers which are also free from any phone:

15 - SAMU (Service d'Aide Médicale d'Urgence) for serious medical emergencies with ambulances and specialist medical teams.

18 - sapeurs pompiers are the fire brigade but they also respond to car accidents and emergency medical situations.

17 - police (commissariat de police or gendarmerie).

112 - sea and lake emergencies (calling from land).

116 117 - out-of-hours doctor (2017)

See a full list of emergency numbers in France and support helplines.

Useful French medical phrases

Click for a full list of medical French phrases.

Besoin une ambulance: I need an ambulance

J'ai eu un accident: I've had an accident

Ma localité est ...: My location is...:

Crise cardiaque: Heart attack

Très malade: Very ill

Je suis en train d'accoucher: I'm in labour

Où est-ce qu'on peut trouver un cabinet médical? Where can I find a doctor's surgery?

Au secours : Help!

More information on the French healthcare system

You can phone the Ameli English-speaking advice line for information about French healthcare insurance: call 3646 from within France; +33 811 70 36 46 from abroad.

Cleiss (Centre des Liasons Européennes et Internationales de Sécurité Sociale) provides information about healthcare in France and the social security system.

To find any kind of health professional or hospital, see this page of the Ameli website.

Read about all types of insurance in France, detailing both mandatory and precautionary insurances.

Compare healthcare systems in other countries

Click to go to the top of our guide to the French healthcare system.

Bupa Global offers international health insurance to expats in more than 190 countries worldwide.
Need advice? Post your question on Expatica's free Ask the Expert service to see if we can help.

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French healthcare system: A guide to the France health care system. Everything you need to know about healthcare in France. Finding a doctor / specialist, going to hospital.. | What you need to know about the healthcare system in France, including doctors, dentists, health insurance and maternity care.

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Infant Mortality rates

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Life Expectancy

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Top 20 causes of death in Framce

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Health Care cost in France

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1.1. A System Under Pressure

The system of health care in France is known as l'assurance maladie, or the Sécu, an abbreviation of sécurité-sociale, although the latter term is often also used to refer more generally to the system of social security in France.

It is often rightly praised for the quality of the treatment and the level accessibility it offers to patients.

France certainly spends a lot of money on health, around 10% of gross national income, one of the highest rates in the world.

Perhaps as a result of this expenditure the French enjoy a life expectancy only exceeded by that of the Japanese!

Nevertheless, the system is under severe financial pressure, there is a growing shortage of suitable staff in many regions, and a higher proportion of the running costs are having to be picked up by patients.

At an institutional level the organisation and financing of the system is complex and is often characterised by high levels of tension between the various parts of the system.

Most health professionals who work outside of hospitals are self-employed and depend for their income on fee paying patients whose costs are reimbursed by the social security and voluntary health insurance systems.

Patients, in turn, have been allowed to have unrestricted access to doctors and specialists with the result that no-one in the health system has had any particular incentive to keep down costs.

Over the past few years the government has introduced a series of reforms, the whole purpose of which is to increase efficiency and drive down costs. These reforms are on-going.

Social security health contributions have been increased, as have fees for medical consultations, whilst reimbursement levels have been reduced.

At an administrative level everyone is now required to register with a doctor to obtain the full level of reimbursement, medical records for patients are to be introduced, and there have been some reforms to the institutional structure.

Continuing concern about rising costs has resulted in stronger controls by government limiting the freedom of professionals and patients and controls on the prices of drugs.

To anyone from outside of France some of these reforms may appear logical and long overdue, but there is widespread concern in France about their impact.

Many health professionals consider the changes are too bureaucratic, and there are many commentators who consider that the costs of health care are going to increasingly fall upon poorer members of the community and those who are ill.

In short, like most other developed nations, France can no longer afford its health service.

1.2. Structure of Health System

Health care in France is funded by a dual system of health insurance comprising:

A State controlled health insurance social security system, called l'assurance maladie and;

A separate voluntary health insurance system called assurance complémentaire provided through mutual organisations and private insurers.

Whilst the social security system picks up most of your health costs, you will need to take out voluntary health insurance to cover those medical costs that will not be picked up by the State, although it is not compulsory to do so.

We will review voluntary ('top-up') insurance in later pages but, for now, we just consider the State funded part of the system.

Accordingly, in order to obtain access to the health service in France, and obtain reimbursement of costs, you need to be registered with l'assurance maladie.

Historically, l'assurance maladie comprised a number of private or mutual insurance bodies who collected insurance premiums from their clients, which were then used to pay for the costs of health care.

They developed after the Second World War as a series of mutual schemes between employers and employees, and the present arrangements still bear the hallmarks of this approach.

Although the insurance funds continue to be ostensibly 'private' organisations they now operate under the supervision of the government, who have ultimate financial responsibility.

Accordingly, the funds are now effectively a branch of the state social security system.

The main health insurance fund is a General Fund called the Régime Général that covers about 85% of the population working in industry and commerce, as well as the unemployed and those retired and not affiliated to another fund.

Within the Régime Général the Protection Universelle Maladie (PUMA) guarantees permanent health cover for all those who are legally entitled to reside in France, whether in work or inactive.

At a local level the General Fund is administered by a health authority, called the Caisse Primaire d'Assurance Maladie (CPAM).

If you are planning to run your own business in France there is a separate State controlled insurance scheme for the self-employed called Régime Social des Indépendants (RSI).

You will not be able to use the local CPAM if you are self-employed and, therefore, affiliated to the RSI. They only have regional offices, so you many well find yourself having to deal with them on the phone or via the internet.

Since 2018 the RSI is in the process of being abolished, so that all those affiliated will be transferred to their local CPAM.

There are then separate health insurance funds for agricultural workers and other smaller schemes for specialist professions, e.g. civil servants, railway workers, doctors.

Next: Getting Health Cover

Back: Index - Health Care in France

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French Health: Overview of health system in France

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The system of health care in France is known as l'assurance maladie, or the Sécu, an abbreviation of sécurité-sociale , although the latter term is often also used to refer more generally to the system of social security in France. It is often rightly praised for the quality of the treatment and the level accessibility it offers to patients.

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The Social Security System is a state controlled health insurance. Social Security System covers majority of the health costs given.

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The Geography of France