The Inspectorate General of Finance and Inspectorate General of Social Affairs have recommended ‘structural reform’ of the France's long-term illness care system for 2025 to ensure its financial sustainability.
The system, known as ALD (affection de longue durée) relates to any illness that is long term and/or sufficiently serious to warrant prolonged, ongoing medical treatment.
ALD currently supports 13.7 million patients (around 20% of the population) facing the challenges and costs of long-term care in France. These illnesses fall into two categories: ALD exonérante and ALD non-exonérante.
ALD exonérante
ALD exonérante applies when you suffer a serious illness that lasts for more than six months and requires costly treatment.
With ALD exonérante, healthcare costs are covered up to the maximum that can be refunded by social security. However, this only covers treatment directly related to the illness and you still have to pay for certain expenses such as the €2 fixed contribution, excess fees and fixed hospital charges.
Illnesses that fall into this category include diabetes, heart disease, cancer and Parkinson’s disease, which generally require costly treatments over a long period.
Your doctor can officially request for an illness to be recognised as ALD exonérante, and if accepted you will be refunded to the maximum level for doctor’s appointments, prescriptions, hospital visits and transport.
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ALD non-exonérante
ALD non-exonérante relates to long-term illnesses that do not necessarily require costly treatment. In this case, you will be refunded at the usual rates, but you have extra coverage: you can take sick leave for more than six months and (subject to certain conditions) you can access free transport for medical appointments.
Illnesses that would typically fall into this category include glaucoma, arthritis, epilepsy and hypothyroidism.
What difference does it make?
For patients who qualify as having fully exempt ALDs, it is a vital financial resource, enabling patients to follow full medical treatment without going into debt to cover the expense.
The University of Michigan estimates that treatment and medication for a patient with type 2 diabetes costs an average of €13,500 a year, while the National Cancer Institute states that a cancer patient would spend an average of €39,000 for initial care, €5,000 for continuing care and over €99,000 in the last year of life.
For non-exempt ALDs, Ameli gives an example of someone with a mental health issue that does not require costly treatment but will need long-term care, therapy and maybe long-term sick leave. If medication means that s/he cannot drive, they could access free transport for appointments.
Read more: How do French healthcare costs change for long-term illnesses?
How do I declare an ALD to social security?
Firstly, you must be registered with a GP (médecin traitant), update your carte Vitale health card and have an account with Ameli, allowing you to track payments and refunds.
Ameli also recommends that you set up your health account, Mon Espace Santé, enabling medical professionals to consult your health records.
The quickest way to declare an ALD is via an appointment with your GP, who will fill in a ‘health protocol’ form, which is sent off to social security services and assessed by one of its medical officers, who decides which treatments it will cover, and to what amount.
Once this is done, your doctor will draw up an agreement, and your condition will be listed on your social security account within 48 hours.
If you suffer from a long-term illness that is not on the ALD 30 list (the main list of long-term immnesses), your condition may fall under the category of ALD 31 – “serious illnesses which develop over a period of more than six months, the treatment of which is particularly costly”.
There are also cases of ALD 32 patients, where a “combination of several conditions result in a disabling pathological state requiring treatment lasting more than six months and which is particularly costly”.
How could the current system change?
Earlier this year, the government confirmed that a review of the current system was under way and could lead to changes.
According to the then Health Minister Frédéric Valletoux, two-thirds of social security reimbursements concern ALDs. “We also know that… with the ageing of the population and the rise in chronic pathologies, costs are only going to increase,” he added.
Changes to patient transport deductibles are among cost-cutting ideas that have been mooted, as well as ending exemptions from co-payment for certain procedures and products, such as drugs with “low medical value”, spa treatments or drugs not specific to pathologies recognised as ALD.
However, no concrete announcements have been made.
Read more: Long-term health patients fear reimbursement reforms in France
How do I find out more?
You can ask your GP, visit your local CPAM office, or call Assurance Maladie on 3646 for more information.
