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HEALTH

Explained: Why do the French love thermal spa cures so much?

Thermal spa treatments in France are incredibly popular and can even be prescribed by doctors for conditions ranging from heart disease to digestive problems.

A women receives a thermal bath treatment in France.
A women receives a thermal bath treatment in France. Such procedures can reimbursed by the French state if carried out for medical reasons. (Photo by GEORGES GOBET / AFP)

How big is the thermal spa sector in France? 

326,000 people visited thermal spas for treatments in 2021 according to the head of the Conseil national des établissements thermaux (National Council of Thermal Establishments). Those who visit these places are known as curistes

There more than 100 stations thermales in France – establishments that provide medical care with heated mineral water and mud. 

France has more than 770 thermal springs which provide the key ingredient for such treatments.

In 2019, there were 850 doctors specialising in delivering thermal treatments in France. That same year, 0.15 percent of reimbursement payments made by the Assurance Maladie (the French public health system) went to people who had undergone thermal spa treatments 

Those representing the sector say that it employs more than 100,000 people directly and indirectly. 

How does it work? 

We’re not just talking a spa day here.

A cure thermale is different from thalassothérapie – the former is used to treat medical conditions and must be proscribed by a doctor while the latter is used simply to relax. If you go with a few friends to a spa for a day of relaxing and gossip with a massage, a sauna and perhaps a facial that is not a cure thermale

You can receive treatment in a cure thermale for problems linked to rheumatology (conditions like arthritis), gynaecology, phlebology (veins), neurology, cardiology, urology, dermatology, child development, digestion, metabolic issues, psychosomatic illness, respiratory problems and buccolingual health. 

Power showers form an integral part of spa therapy treatments in France

Power showers form an integral part of spa therapy treatments in France. (Photo by GEORGES GOBET / AFP)

The standard duration of a cure thermale treatment is 18 days, which are divided into periods of treatment, physical activity and rest. 

The treatment generally begins in the morning and last between 2-3 hours. Patients will undergo 4-6 treatments per day. They can be delivered individually or as part of a group depending on the prescription given by a doctor. 

The exact treatment you will receive is determined by a doctor once you arrive at a station thermale depending on your illness and overall state of health. Common features are massages, steam room sessions, mud baths and power showers. 

Is there any science to support the idea that these treatments are useful?  

Representatives of the cure thermale sector point to studies written by thermal medicine researchers which, surprise surprise, show thermal spa treatments to be effective in treating a whole range of conditions. 

But other research has also pointed towards benefits. A paper published in the British Medical Journal found that thermal spa therapy was an effective treatment for the management of knee osteoarthritis; and other peer-reviewed studies found that the mineral water used has health benefits. 

READ MORE Are the French falling out of love with spa cures?

But there are sceptics however.

“Medical benefits of thermal treatment have been observed in patients with rheumatic conditions, psoriasis, venous insufficiency, ENT conditions, gynecolgical disorders, and anxiety. Unfortunately, many publications in this area suffer from methodological flaws,” notes the French National Academy of Medicine

A lack of control groups and financial interests behind many of the studies into the efficiency of thermal medicine means that the jury is still out on thermal spa treatments. 

How can I get my spa treatment reimbursed? 

You can pay for treatments yourself, but depending on your state of health the government might pay some of the costs, as the French social security system has been reimbursing cure thermale treatments since 1947. 

You can get your treatment partially reimbursed by the French state if you have obtained a prescription from a doctor. You can get one stint in a thermal spa reimbursed per year, for 18 days. Reimbursement typically amounts to 65-70 percent of the cost of the treatment and is transferred into your bank account after you have paid for the treatment itself. You need a French carte vitale to benefit. 

READ MORE How to get a carte vitale in France and why you need one

Thalassothérapie – the relaxing spa day – is not reimbursed. 

Your doctor is the one who decides which thermal spa you should attend – each one is specialised in treating certain illnesses. 

Before receiving treatment, your doctor will have to sign and provide you with this form, which must then be submitted to the Assurance Maladie (French public health system). You must also fill out a déclaration de ressources, providing evidence of your salary or any other earnings. This must also be sent to the Assurance Maladie – you can find the postal address where you must send your documents in the démarches à accomplir section of this website

If you earn more than €14,664.38 annually, your transport costs to the treatment centre or stay at a hotel will not be reimbursed by the French state. If you earn less than this, you should submit evidence and can have 65 percent of transport (the price of a second-class SNCF ticket to the treatment centre) and hotel fees paid (up to €97.50 per day) back to you. 

How has the Covid-19 pandemic affected the sector? 

Covid-19 has hit the thermal spa sector hard. 

The National Council of Thermal Establishments says that the number of clients receiving treatment was 43.3 percent lower in 2021 than in 2019, before the pandemic began. 

Thermal spas in France have been forcibly closed for months at a time during the pandemic.

Thermal spas in France have been forcibly closed for months at a time during the pandemic. (Photo by GEORGES GOBET / AFP)

Access to thermal treatment centres is contingent on being fully vaccinated (for now, not all centres require you to have had a booster); a negative PCR test taken 72 hours before entering the centre if you are unvaccinated followed by bi-weekly tests during your treatment; or proof of recovery of Covid (a positive test between 11 days and 6 months old). Mask wearing is required in communal areas of treatment centres. 

Dozens of thermal spas in France have begun treating patients with symptoms of long Covid, such as loss of taste and smell, chronic fatigue and brain fog. These treatments are not currently reimbursed by French social security, but the sector is trying to negotiate a deal with the Health Ministry to make this happen. 

“Thermal medicine can contribute to the management of certain after-effects of Covid-19 by a support to more efficient ventilatory mechanics and motor functions and by a relief of the stress following a prolonged stay in an intensive care unit,” said the National Academy of Medicine. 

Other information 

You can read more about the process of getting thermal spa treatments reimbursed here

The National Council of Thermal Establishments has an interactive map where you can search for treatment centres by geographical area and speciality. 

If you are interested about the alleged benefits of thermal spa treatments, an exhibition is currently being held at the Carousel du Louvre in Paris, until January 23rd. Tickets are free but you must subscribe to the event here

Lyon will also hold an event bringing together thermal spa practitioners from January 28th to January 30th at the Eurexpo centre. You can get more information about that event here.  

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TRAVEL NEWS

Paxlovid, tests and isolation: Covid care for tourists in France

With travel opening up, many people are planning trips to France over the next few months, but the Covid pandemic has not gone away. Here are your questions answered on testing, isolation and medical treatment if you do fall sick while on holiday.

Paxlovid, tests and isolation: Covid care for tourists in France

Travel rules

Covid-related travel rules have mostly been relaxed now but you will still need to show proof of being fully vaccinated at the French border. If you are not vaccinated you will need to show a negative Covid test – find the full breakdown of the rules HERE.

Testing

Once in France if you develop symptoms or you have been in contact with someone who has tested positive you will need to get a Covid test.

The good news is that testing is widely available in France, both for residents and tourists.

The easiest way to get a test is head to a pharmacy, most of which offer the rapid-result antigen test on a walk-in basis Tests are available to everyone who wants one, there is no need to fulfill any set criteria.

For full details on how to get a test, and some handy French vocab, click HERE.

The difference for tourists is that you will have to pay for your test, while residents get their costs reimbursed by the French state health system.

In the pharmacy you may be asked for your carte vitale – this is the health card that residents use to claim refunds. As a tourist you won’t have the card – you can still get the test, you will just need to pay for it. Costs vary between pharmacies but are capped at €22 for an antigen test or €54 for a PCR test.

Isolation

If your test is positive you are legally required to isolate, but how long your isolation period is depends on the your vaccination stats – full details HERE.

Treatment

For most fully-vaccinated people without underlying health conditions the symptoms of Covid are fairly mild, but if you do become ill, here’s how to access medical help while in France.

Pharmacy – one of the first things you will notice about France is that pharmacies are everywhere, just look out for the green cross. As well as selling over-the-counter medication, pharmacies all have at least one fully-qualified pharmacist on the staff who can offer medical advice. 

Take advantage of pharmacists – they train for at least six years so they’re very knowledgeable and they’re easy to access by simply walking into the shop. In tourist areas it’s likely that they will speak English. Pharmacists can also signpost you to a nearby doctor if you need extra help.

Doctors – if you need to see a doctor, look out for a médecin généraliste (a GP or family doctor). There is no need to be registered with a doctor, simply call up and ask for an appointment if you need one. If you have a smartphone you can use the medical app Doctolib to find a généraliste in your area who speaks English. You will need to pay for your consultation – €25 is the standard charge and you pay the doctor directly using either cash or a debit card.

You may be able to claim back the cost later on your own health/travel insurance depending on the policy.

Ambulance – if you are very sick or have difficulty breathing you should call an ambulance – the number is 15. All non-residents are entitled to emergency treatment in France, whether or not you have insurance, but if you are admitted or have treatment you may need to pay later.

READ ALSO Emergency in France: Who to call and what to say

Paxlovid – several readers have asked whether the Covid treatment drug Paxlovid is available in France. It was licenced for use in February 2022 and is available on prescription from pharmacies, mainly for people with underlying health conditions or an impaired immune system. You can get a prescription from a medical practitioner.

The drug is reimbursed for French residents, but as a tourist you will have to pay.

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