The French health service is changing

When we first lived in France, about 15 years ago, I was taken aback by the differences in the health services between France and the UK. I kept having to remind myself that I couldn’t walk off without paying - I’d have to pay before I left the surgery.

GPs were very inclined to prescribe anything you wanted, or could possibly want. When one of my sons had tonsillitis I can remember coming away from the pharmacy with 440 FF (66 euros) worth of pills and potions. One of them turned out to be some sort of salt water gargle! Yes, the money was reimbursed (though not fully) but you had to collect the little stickers from the packets and send them off.

What is more, if you were so inclined, you could go to each and every doctor in the vicinity, presumably collecting prescriptions as you went along. You could also go to any specialist you wanted to without being referred by a GP. Seventy percent of costs were covered by the state and the remaining amount by top-up insurance.

I know things have changed. There are posters up in pharmacies assuring people that generic medicines are perfectly OK. You have to register with one GP, your medecin traitant. You have a carte vitale and are computerised. You can no longer take yourself off to a specialist without a referral, apart from gynaecologists, ophthalmologists, and dentists, without incurring a financial penalty. ( I’m intrigued to know why gynaecologists should be exempt.) The state no longer covers the full costs: there is a non-refundable charge of 1 (one) euro and any treatment costing over 91 euros has a charge of 18 euros. There is supposed to be a safety net for the most vulnerable.

All those years ago a friend’s husband fell from a ladder and damaged his back. He was hospitalised and received excellent treatment, but he was self-employed and they struggled with the loss of income and paying hospital bills. It took ages for the state and insurance payments to arrive. As my friend said, the authorities are very quick to take your money but very slow in giving any back. I don’t know whether this has improved or not - it would need to.

I gather from The Lancet the health service is still in considerable debt so Sarkozy is planning to introduce yet more measures: to increase the non-refundable charge from 1 euro to 10 euros; to control drug prescriptions further; to tighten up on excessive sick-leave; and to reduce the levels of state reimbursement when people self-refer to specialists.

It seems that medical staff are not happy.