France has the largest land area in Europe housing 64,303,482 as of January 2009. This ranked France as the 23rd most populous country in the world. It is responsible for most of the population growth in the European Union. The estimated birth rate as of 2000 is 12.73 births in every 1,000 of the population. Infant mortality at the other hand is 4 deaths per 1,000 live births, which is relatively lower than other developed countries.
Important demographic data that represents quality of health care include life expectancy and death rate. Life expectancy is one of the highest among OECD countries estimated at 77.68 years for males and almost 84.23 years for females. It was the highest achieved life expectancy rate in the world for those born in the year 2000. Death rate on the other hand is 4.2 per 1000 live births.
In addition to the natural population growth, there are a number of immigrants coming in to France annually. In 2006 alone, there are more than 93,600 net immigrants in which about 65% are Africans, 10% are Europeans, and the rest of the 25% are from other nations. In 2006, the total immigrants in France are about 4.9 million comprising 8% of France’s population. Most of the immigrants are European descent with Swiss and Dutch topping the population at 19% and 18% respectively. Others came from the Sweden, United Kingdom, Germany, and some minorities from South and South Asia, Middle East, and Africa.
About 65% of the population is between the age of 15 and 65 years. At this age, a person is considered at his productivity peak. The productivity of the French people is the highest among the G7 countries at 47.7 US dollars. Despite this, only around 69% of those within the age range of 15 to 65 are actually working. France ranks in this indicator way below the United States, Japan, United Kingdom, and Germany.
Health Care in France at a Glance
French health care is regarded as the best in the world. It was ranked 1st by the World Bank in its year 2000 assessment. Universal health care is provided free or highly subsidized by the government. France’s budget allocation for health care is about 11.2% of the GNP. However, this puts much burden to the French government entailing about €11billion in budget deficit at the end of 2004 and is estimated to increase at €70billion at the end of 2020.
Management of France’s health care is through the Social Security system. Health care funds are mostly derived from incomes of France’s working population. It is estimated that almost 20% of an employee’s compensation including employer contribution is remitted to the government. Of this amount, 12.5% is contributed by the employer while 0.75% by the employee and 7.5% social security tax also collected from employees. These account for 60% of the Social Security fund while other fund sources include indirect taxes from alcohol and tobacco.
Health care is highly socialized. It does not discriminate any income levels wherein everyone is entitled to an equal level and quality of service in both public and private institutions. There is also no waiting list for the conduct of surgical procedures. Everyone can consult any health practitioner he/she wants in any public or privately run hospitals or clinics. This was echoed in a post on France Expat Forum last July 9,2009:
Normally, those coming from other EU countries get the appropriate paperwork from their home system, basically attesting to their eligibility for coverage in their home system. The E111 has now been replaced by the European Health Insurance Card (EHIC). This will give you coverage for a certain period of time in France while looking for a job. Might be best to check with the Irish consulate to find out if you’re eligible for an EHIC.
The EHIC coverage is supposed to be at a level equal with French residents covered by the system – and French coverage for maternity benefits is actually very good. You should be aware, however, that the French system is a reimbursement system. You pay the doctor, lab or whatever and then you are reimbursed by the state system.
There are also specialized insurance schemes aside from the general insurance, such as the self-employed, artist, traders, farmers and specialized occupational groups. The poorest population and those suffering from long term illnesses are fully covered by the government.
France is implementing a standard tariff scheme in all services. Medical practitioners are categorized as either conventioné or non-conventioné. Conventioné practitioners adhere to the standard tariff rate while the non-conventioné can charge the rate they like. However, almost all health practitioners (97%) are conventioné, even the private ones for competitive reasons.
The usual rates for professional consulting are €21 for a médicin traitant, €24 for children aged two-six years old, and €25 for children under 2 years old. An additional euro is charged but is non reimbursible by the patient.
Services and prescribed medicines are not fully reimbursed. Oftentimes, this based on the income level of the individual or a family. Typical reimbursement rate is 95% for a major surgery, 80% for a minor surgery, 95% to 100% for pregnancy and childbirth, 65% for prescribed medicine with blue labels and 35% for white labels, 70% for x-ray, and 75 to 80%% for GP/specialist consultations and treatment. Thus around 80% of the French population still avails of supplemental health insurance to cover the difference in actual cost and reimbursed amount. This again costs employees with about 2.5% of their salaries. Most supplemental health insurance is provided by employers as part of their employment benefits.
As shared in France Expat Forum last July 10, 2009:
If you’re working and paying into the cotisation system, you and your family are covered. The French system is a reimbursement system – again in two parts. The state health care system reimburses about 70% of most routine health care, and then most people have a mutuelle that pays the rest according to the terms of the specific contract you have. Your employer usually provides the mutuelle – with the cost split 60-40 between employer and employee – but if your employer doesn’t have a mutuelle, you can always get your own.
Sécu (the government system) is based on a % of your salary, while the mutuelle is a set fee per person covered (usually about half price for children under 18).
Normally you pay the doctor (there is a set fee schedule from the government) and then you are reimbursed directly into your bank account – the sécu forwards all necessary information to your mutuelle. Quite a nice system, actually.
Considerations for Visitors of France
Visitors are generally not required to take any vaccinations. However, the risk is low but there are incidences of rabies and bird flu. Proper precaution is therefore advised. There is also a high risk for tick-borne encephalitis when going to forested areas. Thus, vaccination may be required if traveling in such areas.
Emergency care is provided free particularly for European visitors with valid European Health Insurance Cards. However, visitors to France are advised to carry with them full travel insurance.
United Kingdom expatriates with E106 will be able to avail of the cash reimbursement benefit. However, this is only valid for two years and strictly adheres to the fiscal year schedule of January to January. For example, if the UK national arrived in France in July, then only 6 months remains for that fiscal year to utilize his E106.
Once the E106 expires and the UK national is not qualified to avail of the E121m yet, he has to apply to the CMU (Couverture Maladie Universelle). This will entitle them to the carte vitale or the “green card” to officially make them residence of France. This will entitle them to avail of the standard medical reimbursements. Similar to the French, the UK national may avail of the “top up” insurance policies. The two (2) UK insurers in France are Goodhealth Worldwide Limited and The Exeter Friendly Society.
There is also a recent announcement from the French authorities that British nationals as well as other EU residents in France who are not working but are not yet of the retirement age will be considered as economically inactive. Their green card will be cancelled along with their health cover. These changes do not affect those that are in the retirement age and have the E121 form.