'Medical tourism' - why France wants to crack down on foreigners using the carte vitale
France's social security minister has announced a raft of new measures aimed at cracking down on benefit fraud, including people using the French health system when they are not entitled to.
Social security minister Gabriel Attal used an interview with French newspaper Le Parisien to announce a range of 'crackdown' measures on foreigners accessing French social security provisions - from benefits to pensions to healthcare.
You can find the full breakdown of what he said here, although these all seem to be at the ideas stage, with few concrete details announced.
One aspect of his announcement was a plan to link the carte vitale health card to the French carte d'identité ID card - which would pose a problem for non-French people resident in France, since the French ID card is only available to French citizens.
Attal said: "The issue now is cartes vitale used for illegal medical tourism."
He added: "I want to move gradually towards merging the carte vitale card and the identity card into a single secure card, as is the case in Belgium, Portugal and Sweden. This is both a simplification measure and an additional guarantee of the individual's identity and associated rights."
But is medical tourism actually a problem in France?
Access
The French health system is a reimbursement system - you pay upfront at the doctor, pharmacy, clinic etc and then the state reimburses some or all of the cost of your treatment.
READ ALSO How France's healthcare system works
This means that it's not a problem for people not registered in the French system to access treatment in France - you simply pay upfront like everyone else, but the costs would not be reimbursed by the French state.
This is how tourists can access medical care in France if they need it - they either pay the costs themselves or claim them back later through their own travel insurance or health insurance.
READ ALSO How to access non-emergency medical treatment in France
Carte vitale
The way that people get state-funded healthcare is through the carte vitale - this green credit-card sized card proves that you are registered in the French system and therefore entitled to reimbursement on healthcare costs. After you have paid for your treatment/appointment/prescription you hand your carte vitale to the doctor or pharmacist, who swipes it through a special machine.
The reimbursed costs are then paid directly into your bank account, with the percentage of reimbursement automatically calculated based on the type of treatment you had and your personal circumstances (eg if you are pregnant, unemployed or a war veteran).
Most residents also have top-up health insurance, known as a mutuelle, to cover the remainder of the costs.
Reimbursement
In most cases, the reimbursement is paid by the French state, but there are some exceptions for foreigners.
People who have retired to France generally have their healthcare costs paid by their home country, if there is a reciprocal agreement in place - for example British pensioners who retire to France usually have their costs paid by the NHS under the S1 scheme. This is also applies to some other groups including students and posted workers.
Foreigners who are working in France and paying social contributions have their healthcare paid for by the French state.
In both cases, foreigners living in France have a carte vitale - the difference is who reimburses the money, but for the patient the process is identical; pay upfront, swipe the carte vitale and wait for the reimbursement to arrive in your bank account.
Anyone who has been legally resident in France for more than three months is entitled to a carte vitale (although the actual process of applying can be quite a long one, often taking up to 12 months).
READ ALSO How to get a carte vitale
Medical tourism
So is there actually an issue with foreigners accessing state reimbursement when they're not entitled to it, since foreigners legally living in France are perfectly within their rights to register in the French system?
Attal said the problem was: "People coming to France and using someone else's carte vitale for treatment."
Over the last five years, 2.3 million cartes vitale have been deactivated because they were "surplus", according to Attal.
There have also been relatively recent charges to the card to add a photo, making it harder to use someone else's card, although a proposal to add biometric information such as fingerprints appears to have been abandoned on the grounds of cost (an estimated €250 million) and complexity.
The minister said that the Cour des Comptes (French Audit Office) estimates the total cost of social fraud at between €6 billion and €8 billion a year - but that figure includes all types of social fraud (medical costs, fake sick notes, benefit fraud etc) from both French and non-French people.
On medical fraud - by both French and non-French citizens - he said there was no precise data, but it was believed to cost "several million a year".
Health tourism
France does, however, have a thriving and completely legal health tourism sector - where foreigners travel to France for treatment in private clinics at their own expense.
A network of private clinics exist and many target foreigners to come to France to get treatment that is either not available in their own country or is cheaper in France.
Mickaël Guignier, the CEO of Medifrance Solution private clinic, told BFMTV that: "Nearly half of our patients come from Africa, a third from Eastern Europe. And around 10 percent come from the UK and Ireland, but for reasons of waiting lists."
Some patients choose France because of the cost of treatment, with Guignier adding that: "Coronary bypass surgery costs ten times more in the United States than in France. There's a real market out there."
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Social security minister Gabriel Attal used an interview with French newspaper Le Parisien to announce a range of 'crackdown' measures on foreigners accessing French social security provisions - from benefits to pensions to healthcare.
You can find the full breakdown of what he said here, although these all seem to be at the ideas stage, with few concrete details announced.
One aspect of his announcement was a plan to link the carte vitale health card to the French carte d'identité ID card - which would pose a problem for non-French people resident in France, since the French ID card is only available to French citizens.
Attal said: "The issue now is cartes vitale used for illegal medical tourism."
He added: "I want to move gradually towards merging the carte vitale card and the identity card into a single secure card, as is the case in Belgium, Portugal and Sweden. This is both a simplification measure and an additional guarantee of the individual's identity and associated rights."
But is medical tourism actually a problem in France?
Access
The French health system is a reimbursement system - you pay upfront at the doctor, pharmacy, clinic etc and then the state reimburses some or all of the cost of your treatment.
READ ALSO How France's healthcare system works
This means that it's not a problem for people not registered in the French system to access treatment in France - you simply pay upfront like everyone else, but the costs would not be reimbursed by the French state.
This is how tourists can access medical care in France if they need it - they either pay the costs themselves or claim them back later through their own travel insurance or health insurance.
READ ALSO How to access non-emergency medical treatment in France
Carte vitale
The way that people get state-funded healthcare is through the carte vitale - this green credit-card sized card proves that you are registered in the French system and therefore entitled to reimbursement on healthcare costs. After you have paid for your treatment/appointment/prescription you hand your carte vitale to the doctor or pharmacist, who swipes it through a special machine.
The reimbursed costs are then paid directly into your bank account, with the percentage of reimbursement automatically calculated based on the type of treatment you had and your personal circumstances (eg if you are pregnant, unemployed or a war veteran).
Most residents also have top-up health insurance, known as a mutuelle, to cover the remainder of the costs.
Reimbursement
In most cases, the reimbursement is paid by the French state, but there are some exceptions for foreigners.
People who have retired to France generally have their healthcare costs paid by their home country, if there is a reciprocal agreement in place - for example British pensioners who retire to France usually have their costs paid by the NHS under the S1 scheme. This is also applies to some other groups including students and posted workers.
Foreigners who are working in France and paying social contributions have their healthcare paid for by the French state.
In both cases, foreigners living in France have a carte vitale - the difference is who reimburses the money, but for the patient the process is identical; pay upfront, swipe the carte vitale and wait for the reimbursement to arrive in your bank account.
Anyone who has been legally resident in France for more than three months is entitled to a carte vitale (although the actual process of applying can be quite a long one, often taking up to 12 months).
READ ALSO How to get a carte vitale
Medical tourism
So is there actually an issue with foreigners accessing state reimbursement when they're not entitled to it, since foreigners legally living in France are perfectly within their rights to register in the French system?
Attal said the problem was: "People coming to France and using someone else's carte vitale for treatment."
Over the last five years, 2.3 million cartes vitale have been deactivated because they were "surplus", according to Attal.
There have also been relatively recent charges to the card to add a photo, making it harder to use someone else's card, although a proposal to add biometric information such as fingerprints appears to have been abandoned on the grounds of cost (an estimated €250 million) and complexity.
The minister said that the Cour des Comptes (French Audit Office) estimates the total cost of social fraud at between €6 billion and €8 billion a year - but that figure includes all types of social fraud (medical costs, fake sick notes, benefit fraud etc) from both French and non-French people.
On medical fraud - by both French and non-French citizens - he said there was no precise data, but it was believed to cost "several million a year".
Health tourism
France does, however, have a thriving and completely legal health tourism sector - where foreigners travel to France for treatment in private clinics at their own expense.
A network of private clinics exist and many target foreigners to come to France to get treatment that is either not available in their own country or is cheaper in France.
Mickaël Guignier, the CEO of Medifrance Solution private clinic, told BFMTV that: "Nearly half of our patients come from Africa, a third from Eastern Europe. And around 10 percent come from the UK and Ireland, but for reasons of waiting lists."
Some patients choose France because of the cost of treatment, with Guignier adding that: "Coronary bypass surgery costs ten times more in the United States than in France. There's a real market out there."
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