France

Health systems in transition France 75
• CMU-C and AME beneficiaries;
• disability pensioners;
• military pensioners;
• minors who are victims of sexual crimes for related treatment; and
• infertility treatments.
For treatments or tests with a tariff over €120, a flat-rate fee (participation
forfaitaire) of €18 is applied instead of the generally applicable co-insurance
amount, subject to the same exceptions listed above. This fee does not apply to
diagnostic imaging, emergency transport or transport between care facilities
(including HAD) and applies only once per hospital stay. Whatever the level
of coverage of care, most patients must pay a flat-rate catering fee ( forfait
journalier) of €18 per day for hospital accommodation (€13.50 in mental health
institutions), subject to the following exceptions: maternity care from the last
four months of pregnancy until 12 days postpartum, newborns in the first 30
days, beneficiaries of CMU-C and AME, occupational injuries, HAD, disabled
children under the age of 20 living in institutions, military pensioners, and
those covered under the Alsace-Moselle SHI scheme. This fee may be covered
by VHI.
Outpatient care provided by self-employed health professionals.
Coverage rates range from 70% of the statutory tariff for health care provided
by doctors and dentists to 60% for medical auxiliaries and laboratory tests.
The €18 flat-rate fee for treatments with tariffs above €120 also applies to
outpatient services in lieu of the applicable co-insurance amount. The flat-rate
fee also applies if the cumulative cost of treatments provided within a single
visit exceeds €120, but in any case cannot be applied more than once per visit.
The reimbursement of services provided by medical auxiliaries and laboratory
tests is conditional on a doctor’s prescription. However, in order to support the
financial incentives to follow a coordinated care pathway, coverage of doctors’
visits can vary. Under the “preferred doctor” scheme, patients are requested
to register with the doctor of their choice, whom they should see to obtain a
referral to a specialist. The preferred doctor is most often a GP, but it may be a
specialist of any kind working in the private or public sector. The coverage of
patients who directly access specialists or other GPs outside of the coordinated
care pathway falls to 30%.