Understand the differences between the French and British healthcare systems

The French healthcare system is a subsidised state system based on reimbursements managed by the Sécurité Sociale (often referred to as la Sécu), which also covers state pensions and family benefits.

It was established after the Second World War on the principle that people contribute according to their means and receive care according to their needs. The system is widely regarded as one of the most effective in the world, with generally good access to GPs, specialists, tests, scans and hospital treatment.

This is not to say it is without challenges. In some rural areas, access to doctors can be more limited than in major cities such as Paris or along the Mediterranean coast.

Although the system is comprehensive, it operates alongside ongoing financial pressures, with a recurring social security deficit and a legacy of accumulated debt.

France nevertheless performs strongly on key health indicators, including life expectancy and rates of avoidable deaths.

How it works in practice

The system operates differently from that in the UK in several important respects. Patients are expected to take a more active role in managing their care – for example, booking their own specialist appointments and keeping copies of medical records such as test results and scans.

Many routine healthcare costs involve paying upfront and then being reimbursed, either partially or in full, by the state system. This applies to consultations with doctors and many outpatient treatments (though hospital stays are often handled differently).

One of the first steps after entering the system is to register with a GP who acts as your médecin traitant (declared primary doctor). This is important, as it ensures access to the best reimbursement rates within the coordinated care pathway.

Most residents also take out complementary private health insurance, known as a mutuelle, to cover the portion of costs not reimbursed by the state. These policies are regulated, and premiums generally increase with age rather than being based on medical history.

Access and eligibility

Healthcare cover in France is primarily based on residence under the system known as Protection Universelle Maladie (Puma).

In general, you become eligible after around three months of stable residence, although interim private cover is often required when first arriving.

If you are not working, or only working to a limited extent, and have significant income from investments or property, you may be required to pay an annual contribution towards healthcare costs. This is known as the cotisation subsidiaire maladie.

‘Medical deserts’

The term déserts médicaux refers to areas with relatively limited access to healthcare, particularly GP services. This is an ongoing issue in certain parts of France, especially rural regions.

Various measures have been introduced to address this, including incentives for doctors to practise in under-served areas and schemes involving rotating cover from practitioners in other regions.

Connexion tip

When referring to healthcare rights in France, this generally means the right to have care funded or reimbursed by the state, rather than the right to access care itself.

In practice, you can consult a doctor or receive treatment without being registered in the system, but you would need to pay the full cost yourself.

Legally, however, long-term residents are expected to have some form of healthcare cover, whether through the state system or private insurance (typically during the initial period after moving).

It is also worth noting that the distinction between public and private healthcare is less clear-cut than in some countries. Many private clinics operate within the state reimbursement system, and fully private care outside this framework is relatively uncommon.