Understand the differences between the French and American healthcare systems

The subsidized state system is based on coverage / refunds run by the Sécurité Sociale (la Sécu) which is also responsible for state pensions and family benefits.

It started after the Second World War, based on people paying in according to their means and getting out according to their needs. And by and large it works – the WHO has called the system the best in the world, and people generally have good access to primary care physicians and specialists and the tests, scans and hospital treatments they need.

This is not to claim all is perfect, especially in some rural areas where there can be relative doctor shortages compared to Paris or the Riviera.

Though the system is rated as one of the most generous and comprehensive in the world, the government continues to deal with an annual social security system deficit, including healthcare. it also continues to face challenges in clearing the underlying accumulated total social security system debt.

France is justifiably proud of its health expertise which keeps the country at, or near to, the top of the tables for areas like life expectancy and low numbers of ‘avoidable’ deaths.

Differences from healthcare in the US include the fact that you are expected to take more initiative – for example booking your own specialist and hospital appointments and collecting and keeping your own X-rays and blood test results.

Also, many common health procedures, such as visiting a doctor, require an upfront payment before some or all of the cost is reimbursed (this is not the case in a state hospital for in-patient care). 

One of the first things you should do once in the French health system is find a local primary care physician to be your médecin traitant (personal primary care physician), which will ensure you are reimbursed at the best rates.

Most people have a ‘top-up’ insurance policy, often called a mutuelle, for the part of healthcare costs that the state system does not repay. These policies are regulated and the prices rise depending on age rather than pre-existing conditions. 

State healthcare rights are closely linked to residence – this is known as Puma (Pro­tection Universelle Maladie). 

However, if you are not working (or only for a few hours a week) and have substantial amounts of capital income (from shares and investments, or renting out or selling property) you may have to pay a fixed annual fee towards your healthcare called the cotisation subsidiaire maladie. 

As of 2026, a new fee is expected to be introduced which will be payable by people who do not work in France and live largely off forms of foreign income that are not subject to French social charges, such as US pensions. The details of this fee are still being worked out. 

Note that three months is typically the period of residency required before access to the system is granted.

‘Medical deserts’

A ‘medical desert’ is a term referring to parts of the country with poorer than average access to healthcare and in particular general practice doctors. 

Successive governments have introduced policies aimed at combating the problem. 

The map on this page shows ‘red zone’ areas identified as such, where doctors from other areas, or retired volunteer doctors, are being asked to provide part-time cover on a rotation basis. 

Connexion Tip 

When we talk about healthcare rights in France, we are referring to the right to have care funded (often refunded after an upfront payment) by the state as opposed to the right to go and have a consultation or treatment. 

In fact there is nothing stopping you visiting doctors and paying entirely out of your own pocket if you want to. 

The letter of the law, however, states that a person is not a legal long-term resident if they have no form of healthcare cover, whether via a private policy (usually only in the year after moving over) or from the state. 

In most cases in France there is no strict difference between public and private healthcare – most ‘private’ clinics are run under the usual state scheme of payments and reimbursements. 

Completely private doctors and clinics are rare.