Costs of hospital stays

Hospital fees in a public hospital or a clinique privée conventionnée (private clinic that has signed an agreement with the state) include several elements. These are:

1. A daily non-reimbursed €20 charge towards accommodation and laundry etc. called forfait hospitalier. Most mutuelles cover it.

2. Frais d’hospitalisation. This is a bill for services of the hospital’s medical staff and costs of medicine and equipment. They vary by hospital and department and can mount up to as much as €3,000 a day in intensive care. These are state-reimbursed at 80%, although certain specific procedures with a tariff of at least €120 individually are charged to the patient at €24 (this is only charged once if there are several of them, see bottom of page 34). Cover at 100% for the frais d’hospitalisation start after 30 days’ hospitalisation or in certain cases such as treatment for an ALD.

3. Fees for additional comforts, such as a private room or TV.

Féreuze Aziza, an adviser at France Assos Santé, representing patients, said many items totted up under ‘hospitalisation fees’ do not come under the category of being charged at €24 to the patient, so this can lead to issues notably for patients without a top-up insurance. She said dépassements d’honoraires are not usually the issue in hospital, apart from where a hospital doctor is performing an operation on a private basis – and he or she should always specify if this is the case.

In state hospitals and approved private clinics the tiers payant operates, ie. you do not have to advance the state-reimbursed part of your care. For remaining elements you would formerly be given a bill to pay on leaving hospital, however now in state hospitals you do not need to pay the part covered by your mutuelle. This is gradually being extended to other establishments.

Note that there is an option called hospitalisation à domicile (hospitalisation at home) that can be suitable to some conditions. This involves a high-level of regular care from visiting professionals while you stay in your own home, and it aims to reduce pressure on hospitals. Reimbursement is the same as for hospitals apart from the fact that there is no forfait journalier.

A section is available on the website of the Haute Autorité de Santé (HAS) to compare the quality and safety of healthcare in every French public hospital and private clinic. The HAS is an independent public body which promotes quality in healthcare. Its QualiScope tool is available here. You can insert an establishment’s name in the search box, and when it comes up click rechercher (search). Click again on the name of the hospital in the search result to read the establishment’s report. 

Alternatively, look for establishments within a certain rayon (distance from) a given postcode area and/or search by medical service, such as cancerology, surgery or obstetrics. In your search results you can also click a button against an establishment’s name to ‘add it to the comparison tool’. If you add two or more hospitals or clinics in this way you can click an icon to the right-hand side of the screen to see graphics on how they compare according to various criteria.

Any adult can write directives anticipées (a ‘living will’) to clarify end-of-life wishes should they find themselves seriously injured or terminally ill and unable to express themselves. In the absence of this, family or friends will be consulted, especially anyone you have designated as your personne de confiance – trusted person, named to help you if you are ill. 

A living will can address such decisions as limiting or stopping treatment if you are in a vegetative state; whether or not you would want to be transferred to intensive care to keep you alive at all costs; whether to use artificial respiration or undertake surgeries, or to have palliative care, which may reduce your suffering even if it might cause you to die sooner. 

You can either keep these in a safe place and tell your doctor and family where they are, or give them to your GP or hospital/care home, or save them in your Mon Espace Santé health space (in which case it is still recommended to tell your family).

Emergency hospital treatment 

Emergency treatment is available at the casualty section of a hospital (urgences) or, if on-the-spot assistance is necessary, from the Samu, a mobile paramedical service with its own ambulances. 

Note, however, that the official current advice is to call 15 in a medical emergency, where you can speak to a medical professional who can help judge what you need and direct you appropriately, whether that be e.g. seeing an out-of-hours doctor, going to the urgences or an ambulance being sent out.

Emergency help can also be obtained from the fire brigade (les pompiers – 18), who can intervene. You can also call the general emergency line 112.

Samu assistance is billed depending on the time it takes, at rates that vary around the country. It is usually covered by the Assurance Maladie and mutuelles. 

The pompiers may be called, in particular, in the case of road accidents where someone is at risk or accidents in a public place requiring specialist equipment. In any case if you call the pompiers your call will also be transferred to a Samu doctor to see if they need to attend. If in doubt as to the right service to call, it is best to call 15 or the general emergency line 112.

For A&E visits that do not require hospitalisation, there is a fixed fee of €19.61 which is not state-reimbursed but is covered by mutuelles. It is payable on the spot in some cases, or otherwise later after you receive a bill in the post.

There is a reduced rate of €8.49 for some groups including people with ALDs and people with certain work-related illnesses and disabilities. 

Some groups do not incur any fee. These include pregnant women, newborn babies up to a month old, people with invalidity pensions, people with very serious work-related illness or disability, children who are victims of violence, terrorism victims and recipients of Aide médicale d’Etat (a form of free healthcare for undocumented migrants).