Monday, June 7, 2010

An encounter with French health care

It’s almost time for me to return to the states. After nearly 10 months of living in France, I never succeeded in signing up for Social Security, and therefore health insurance (although I believe that since my pay checks were deducted for this that I would have been reimbursed- eventually- for any medical bills). So, clearly administration in France is a nightmare. However, a recent incident reassured me, that if I were to get sick, I would be taken care of and it wouldn’t cost me les yeux de la tête (an arm and a leg). This incident gave me a glimpse at the system.

My sister came to visit for two weeks in May. It was her first time to Europe, her first time out of the country if you don’t count a few days in Mexico when we were too young to remember. I wanted her to have a great time and for Paris to have a great impression of her. Unfortunately, our staircase had another plan. Her second night here, she missed one or two miserable steps. At first, she was fine. But overnight her foot swelled. My first thought was to go to the pharmacy.

Pharmacists are honestly just awesome here. When I explained what happened to the pharmacist, he took us to a room and looked at her foot. He said he didn’t think anything was broken but recommended she go to a doctor to make sure she didn’t need an x-ray. Nervous, I asked what an x-ray would cost since she wasn’t covered by French health insurance. He grimaced. Oh no. 100? 200? More? I worried. With an apologetic tone he said, “Without French health coverage, it could be up to 30 or 40.”

Next, I accompanied my limping sister to the nearest clinic to make an appointment for later that afternoon. When we came back for the appointment, they asked for her carte vitale (insurance card). After explaining that she’s just visiting France, again with an apologetic tone, the lady said, “then you’ll have to pay the whole fee for the appointment now, but we’ll give you a form and maybe your American insurance will reimburse you.” How much? “22 euros.”

We waited for about 45 minutes in the waiting room where we watched 5 patients be called before us into the exam room. Curious thing about doctor offices (or at least clinics) in France: there are cabines (changing rooms) connected to the exam rooms. So as patients were called, we watched the doctor go through the main door to the room, while the patients went to the cabine. I explained to Jenny that they are probably stripping down and may not have gowns to wear. There are no frills at the doctor or the hospital in France, I hear. “No way am I taking off my clothes for my foot!” she exclaimed. I agreed that would be ridiculous, but after this long day I told her to suck it up if she had to. Luckily, when we were called, Dr. Arnaud just asked her to take off her shoe. She sat on the table and the doctor asked me, “Elle a fait quoi comme bêtise? (What stupid thing did she do?) I like this guy.

Dr. Arnaud confirmed that nothing was broken and that an x-ray wasn’t needed. She had une entorse (a sprain) and he wrote her a prescription for an anti-inflammatory cream, une attelle (a brace) and a set of cannes anglaises (crutches, but those that you hold with your hands and don’t go under your armpits). The doctor even assured us that we could take our trip to Mont Saint Michel and that she could even ride a horse. He even included a funny horse riding demonstration from his chair.

Back to the pharmacy we went for the brace, cream, and rented crutches, which cost about 50 euros. So the day’s worth of medical bills, without coverage, cost under 75 euros.

The standard fee for seeing a (non-private) general practitioner for adults in France is 22 euros. If you are covered by the Social Security health coverage (which are all citizens and residents here long enough to get paperwork finished), 70% of that is reimbursed. Back in March, the doctor unionists (yes, doctor unionists) went on strike. They were demanding that the fee be raised to 23 euros. Well, from what I’ve found on the Internet, it didn’t exactly happen. Some doctors have begun to charge the extra euro, but the Assurance Maladie (Health Insurance) website assures that patients have the right to refuse to pay the extra euro. For Francophiles, this article is interesting if you want to learn more, and this site explains the basics about doctor fees.

I indeed sympathize with the general practitioners who feel constrained by politicians and unappreciated, and I think they deserve the extra euro. Clearly I must admit that there are problems and downsides to the French health care system. Yet, I firmly believe that my sister, as small as her incident may have been, was in competent hands. She was well taken care of, and even without coverage she didn’t have to forfeit all of her traveling money for medical bills.

After doing some research about fees and such in France, I decided I needed to learn more about the new health care plan going into effect in my home country. I knew the very basics, but since it passed, I didn’t understand how and when things would exactly change. Some of the first things to go into effect are that people under 26 can remain on their parents’ health insurance, and that insurance providers cannot deny coverage to children due to pre-existing conditions. As a married individual, I can’t exactly benefit from my dad’s insurance (I assume), but I think that is wonderful. How many 22 year olds find a job with excellent benefits right after college? That’s a much-needed cushion in my opinion. And not allowing insurance companies from refusing to give health coverage to children, well how could you argue with that? Is that not simply just?

Before strangers to my blog begin to bombard me with anti-socialist comments, let me say that I’m admittedly not an expert, and let me change the subject. Another wonderful thing to come out of my sisters’ slight misery was my opportunity to speak French in a new environment. Speaking with pharmacists and doctors and learning new vocabulary was honestly exciting and it felt good, since I’ve not had “new” French speaking experiences lately. So, Jenny, I’m sorry you feel down the stairs, but thank you for the gift of this interesting experience.

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