The French healthcare system is widely recognised as one of the best in the world and despite being costly to maintain it offers every legal resident of France whether rich or poor an unrivalled level of care.

On average, 70 per cent of medical treatment is funded by the state. To make up the difference between the state contribution and cost of treatment, the majority of French residents take out a health insurance policy, this is known as a mutuelle or complémentaire. Although the system is heavily subsidised, it is usual to pay for your minor medical bills upfront, which are then reimbursed within a week or so and paid directly into your bank account.

How you join the healthcare system depends on your circumstances. If you are on holiday in France and live anywhere in the EU you need to have an EHIC (European Health Insurance Card) – an application form can be obtained from your local post office. The card entitles you to ‘necessary’ healthcare but will not cover the cost of treatment for someone travelling to France to be specifically treated for an existing condition.

If you are resident in France it is obligatory to join the French healthcare system. The procedure is different, however, depending on your status. For example, if you are a retired UK citizen and live in France, you can join the system by taking the form E121 to your local CPAM (Caisse Primaire d’Assurance Maladie) office but if you are a UK citizen under the state retirement age, living but not working in France, you need to take the form E106. The CPAM will ask for proof of residence in France – a couple of French utility bills should suffice – as well as a copy of your birth certificate, passport and marriage certificate if appropriate.

Typically it can then take up to eight weeks to receive your social security number and carte vitale – a smart card containing medical and administrative data that simplifies and accelerates the reimbursement process.

I would strongly recommend that if you are coming to live in France you complete the medical and official paperwork before you leave the UK. Contact the Department for Work and Pensions (DWP) at Newcastle upon Tyne (see www.dwp.gov.uk). It is a sad fact that many Brits who move to France fail to prepare adequately. Getting this right will save you unnecessary expense and worry.

Case Study: Linda Shepherd

A routine doctor’s appointment to renew her HRT prescription led to Linda being diagnosed with breast cancer. Her doctor explained that anyone on HRT for three years should have a routine mammogram. One month later at the radiology clinic the consultant gave her the stunning news; ‘See that lump there, I’m 99.9 per cent sure it is cancer. You tell your doctor you need to get rid of it,’ he told her.

As Linda had only been in France for three months she had no insurance in place and had to rely on her E111 (now the EHIC). Once in the system and as her illness was one of the thirty serious diseases, she qualified for 100 per cent reimbursement.

In November 2000 Linda underwent a lumpectomy to remove the diseased tissue and a week later had a mastectomy. Although the cancer had not spread into her lymphatic system, she still needed to undergo a painful and traumatic period of radiotherapy treatment.

The radiotherapy consisted of short doses of radiation, five days a week for five weeks and the stressful daily trip to Poitiers for her and husband Andy eventually took its toll. During treatment Linda collapsed in the hospital corridor. ‘I told the doctor I couldn’t cope anymore and needed to be in hospital. He put me in the psychiatric ward for the last three weeks of my treatment,’ she says.

It was during her psychiatric treatment – all in French – that Linda wondered how anyone who didn’t speak the language would cope in such a situation. ‘Even though I spoke French reasonably well I found it very difficult expressing my emotions in English, let alone in another language,’ she says. ‘You are so fearful of your condition that information simply doesn’t register. I needed emotional support, someone to turn to along the way from the early results of the mammogram and echograph right through to coming home and learning how to cope with life again.’ Despite the limited emotional support available she found the quality and thoroughness of physical care without question and is now in remission.

It was from Linda’s pain and trauma that Cancer Support France was formed; an association run by English speakers, for English speakers. Now in its fifth year, it receives calls from all over France from people affected by cancer. ‘We are here for anybody affected by the disease,’ says Linda. ‘People forget that it devastates not just the sufferer but their families too. We give people reassurance that they are not alone, as well as confidence. I’m living proof of that.’

www.cancersupportfrance.info

Email: linda.shepherd@wanadoo.fr

Tel: 00 33 (0)5 45 89 30 05

Case study: Alex and Thierry David

When Alex and her family moved to France in June 2004, within just 6 months they were to be dealt a cruel blow. They began to notice a change in their 22-month-old baby, Etienne. ‘He was not the Etienne we knew anymore. Before he could say a few words, name the various parts of the body, sometimes talking in both languages, and he gradually stopped,’ explains Alex. By Christmas he had lost all ability to communicate verbally and was unable to make eye contact with them.

Following an initial meeting with Etienne’s paediatrician and an ear specialist, who thought he had a hearing problem, he underwent an operation to have Grommets fitted. One month later, he showed no sign of improvement and they were referred to the main hospital in Bordeaux where he had additional tests and a further operation. Their consultant at Bordeaux, who did not speak English, spent two hours gently breaking the news to the couple that Etienne’s problem was not necessarily deafness and urged them to pursue a different avenue.

Upon their return home they discovered that Etienne’s paediatrician had been to the crèche to observe Etienne in situ. ‘It gave me real confidence to know that the paediatrician had taken his problem seriously,’ says Alex. Etienne was immediately referred to a psychologue (psychologist) who enrolled Etienne into the Hôpital de Jour – a day centre for children with mental difficulties up to the age of nine.

The centre provides Etienne with one-to-one care and offers Alex emotional support. ‘I now had people to talk to who understood what I was going through,’ explains Alex. ‘Although I had to really work at improving my French in order to get the most out of it.’ Two months later Etienne was finally diagnosed with TED – (trouble envahissement développement). ‘We were told Etienne showed traits of autism,’ says Alex. ‘Autism has a much higher profile in the UK than France and the support organisations just aren’t in place here.’

Despite this, the couple are full of praise for the French healthcare system. Etienne’s treatment is free because his condition is classified as critical and there is psychological help available for Etienne’s sister Isabelle, eight, whenever she needs it. ‘The system works fast and at every stage we were dealt with professionally, and referrals were immediate,’ says Alex. ‘There is however a lot of paperwork to fill in, and the lack of relevant support organisations for parents like us is frustrating. We don’t know what the future holds and take each day at a time. We are grateful for every magic milestone Etienne reaches no matter how small and, wait in hope that one day there may be a magical cure.’

www.autismefrance.org

Email: david.thierry9@wanadoo.fr

Autisme Charente: Tel: 00 33 (0) 545 617 443

Case Study: Nicki Brown

Six weeks after Nicki and her family arrived in France, she was referred by her GP to the local clinic for a pregnancy test. With the good news that she was 10 weeks pregnant she had her first consultation with a gynaecologist.

During the consultation she was given a three-page form to complete – the premier examen prenatal – a part of which is sent to the CAF (caisse d’allocations familiales) and a part to the CPAM (caisse primaire d’assurance maladie). She was told that in order to qualify for family allowance, the CAF needed her declaration de grossesse within the first 14 weeks of pregnancy.

Each month, routine blood and urine tests were performed and a copy of the results was then sent to Nicki and her gynaecologist. During her pregnancy, four scans were carried out and were usually accompanied with an internal examination. Nicki was warned by a friend that very early on they can tell the sex of the baby and that it was advisable to tell the gynaecologist beforehand if she didn’t want to know.

By the seventh month of pregnancy, Nicki met with the anaesthetist who discussed the type of pain relief she was likely to require. ‘It was an epidural or nothing,’ says Nicki. ‘The French aren’t big on natural childbirth and home births are almost unheard of.’ Having relied on gas and air with her first baby Maddie, who was born in the UK, she was disappointed that this was not an option. Nicki had one meeting with a midwife (sage femme) two weeks before her due date and was given a final examination and an explanation of the labour procedure.

On 26 June 2005, Nicki arrived at the hospital, presented her social security documents as is necessary in France and then discovered she was too late for an epidural! It is advisable to be at the hospital two hours before the baby is born if you want one. Nicki swiftly gave birth to a baby boy just 45 minutes after being admitted.

‘My only criticism of the birth was not having the freedom to move around,’ says Nicki ‘In the UK I was encouraged to do what felt right but didn’t have that option here.’ The couple also had to name the baby almost immediately after the birth but fortunately they were prepared for this.

Nicki and baby Ollie stayed in hospital for five days and had their own room with bath, TV and phone. There were regular visits and checks from the midwives and three good meals a day although according to Nicki breakfast was a bit light! Her medical care was reimbursed at 70 per cent for the first five months of pregnancy and at 100 per cent from the first day of the sixth month up to the twelfth day after delivery.

Two months after the birth Nicki, was given her postnatal check up and was prescribed ten free sessions of pelvic re-education. She selected her paediatrician who takes care of Ollie’s development and vaccinations, and, now enjoys enhanced family allowance as she has two children with one under the age of three. She is full of praise for the French system. ‘I didn’t feel like a statistic,’ she says. ‘I had the very best care, the system is extremely thorough and nothing was ever too much trouble.’

Best medicine

• Learn the language to get the most out of the system
• Don’t be afraid to ask questions
• If it’s your first baby make contact with other mums in your area
• If you are taking a retirement pension from the UK it’s prudent to check the terms of your health insurance prior to leaving
• Contact the Department for Work and Pensions (DWP) at Newcastle upon Tyne (see www.dwp.gov.uk) to find out which forms you need to fill in