We’ve had the misfortune of having to do a deep dive on the Maladie Assurance, or the French national health insurance, in the last few months. I am going to be brief in talking about our experiences and what we’ve learned.
The insurance covers about 75 percent of medical visits as reimbursements sent directly into your French bank account. Most people have supplemental insurance, called a Mutuelle that covers the remaining 25 percent. We do too.
If you have a chronic disease, such as Crohn’s or Diabetes, or have a serious illness such as cancer, French health covers 100 percent of your medical visits. In my husband’s case, this extends to one month post-op in a rehabilitation center in the hills where he has a view of the old town of Vence and the Mediterranean Sea.
When you are hospitalized, you don’t pay upfront. The hospital registers your treatment with French health, and contacts the Mutuelle for the 20 euros a day that is not covered. Yes, you read that right — without the Mutuelle we’d be out a mere 20 euros a day.
We were impressed with our doctors, all of whom spoke at least decent English, the surgeon being quite fluent. In my mind, the fluency in the official common language of the European Union was a good sign, because it means doctors “keep up” by reading studies, collaborating with other medical institutions on the Continent and attending conferences. The intensive care and other nursing staff were also top notch, although mostly monolingual.
With most public health systems, there is no extra money to spend on niceties such as lovely art on the wall, fresh paint or well-kitted out waiting rooms such as we’ve seen in the US. The hospital with which we grew familiar was a bit of a shock, however. The first waiting room I was in was quite depressing, with mismatched, junk yard type chairs, tears revealing the stuffing and all.
The surgeon said to me, unprovoked, “Don’t worry. The building is ancient but the surgery is very modern.”
There’s little paperwork for doctors, and therefore, no front office. Often a doctor will make his/her own appointments. You pay them directly and they give you a form for the insurance reimbursement. My husband’s surgeon had one staffer, and that is probably because he is also a Professor at the leading medical institution in the area.
To arrive at the building where we were assigned for visiting hours, you could walk about 15 minutes uphill or wait for a shuttle that, it being the holiday season perhaps, almost never arrived. So walk I did, and, it being the holidays, I was always the only person making the trip past darkened and decrepit-looking buildings, only to arrive to my destination where it seemed the only lights that were turned on were in the specific room where my husband was recovering. I was creeped out.
It turned out that these buildings that hardly inspired confidence are slated for demolition. The wallpaper on hospital staff monitors showed a rendering of the soon-to-be-built complex, one that takes advantage of its hill top setting, its natural garden landscape of olive trees and umbrella pines, and its views over Nice and the Sea.
French doctors don’t seem to have the same communication protocols of the US. For example, I never got word when my husband was out of surgery. No call, nothing. I called the hospital, nada. I went to the hospital only to be sent home. In the end, I just showed up again, and by luck in the darkened “lobby” found a staffer who showed me the way to the ICU. There I had a hissy fit about the lack of communication. I did finally get a call from the surgeon’s office — the next day, almost 24 hours later — saying simply that the surgery had been a success with no details offered. By then, of course, I’d forced myself on the staff and gotten more than the gist.
Visiting hours were limited. In our case, one visitor at a time, only 5-7pm, no exceptions. Out of the ICU, hours were more generous — 1pm to 7pm.
Now, is all this beneficence sustainable? My own GP doctor seems to think not. In her waiting room, among the out of date magazines strewn about a coffee table, is a book titled “The Coming Collapse of the Assurance Maladie.” However, it seems the Sécu, the social security service that includes the insurance, operates in the black.
One thing is for sure. You’d get more than a few Gilets Jaunes (see previous post) in the streets if L’Assurance Maladie was ever threatened with cutbacks.