Health System Operation

Access to care

Access to care is for the most part guaranteed under the statutory health insurance system. This allows the mutualisation of what may often be significant costs, that few people could afford on an individual basis.
Patients are however required to participate in health expenditures, with the aim of fostering consumer responsibility vis-à-vis the cost of health care. In some instances the statutory health insurance system provides 100% coverage, as in the case of perinatal care and costs related to long-term illnesses and industrial injury. Otherwise, the co-payment (ticket modérateur) is reimbursed fully or in part by the patient’s mutuelle or private insurance company. Hospital inpatients (with the exception of patients hospitalised on a long-term basis) must also pay a daily flat-rate fee for accommodation.

While remaining faithful to the fundamental principles of private medical practice, the reform of the health insurance system, passed in 2004, introduced a "patient pathways" system, through the institution of a referring (i.e. gatekeeping) doctor. Under the system (with a few exceptions), patients must be referred to specialists by a general practitioner, with whom they have registered as their referring doctor. Patients still have the possibility of self-referring, but in this case they are reimbursed at a lower rate by the health insurance system.
At the same time, the carte Vitale – a smartcard incorporating a microchip containing the patient’s health insurance details – exempts the patient from paying the portion of the upfront cost to be reimbursed by the health insurance fund. This system is in use in many pharmacies and doctors’ surgeries, as well as hospitals and other health care establishments. Some mutuelles or insurance companies also participate in the system with respect to the co-payment part of the cost (part not reimbursed by the health insurance fund).
The 2004 reform of the health insurance system also provides for the creation of a “personal medical record", which will contain medical data in protected electronic format. This new system should start to come on stream in 2007.