Healthcare In Paris

Navigating health care is not typically something one looks forward to, but I’ve been so curious about experiencing the medical system in France that I couldn’t wait to learn about the good, the bad, and the different. I had my thyroid removed last year and am currently pregnant, so it was imperative that I found providers to manage my care right away. In fact, finding the right doctors was probably my number one concern upon planning our move to France.

First, let’s put it out there and acknowledge that France uses Universal Healthcare while the United States does not. This can be helpful to consider when we think about costs and healthcare access. Setting aside any political tendencies or beliefs you may have, it’s important to also acknowledge that the US health care system spends about 75% of its health care resources on hospitalizations and curing disease and very little on disease prevention. Even though we spend more, our outcomes are not any better; on average, Americans have shorter lives and higher rates of disease when compared to people in other high-income countries. French people are expected to live about four years longer than Americans do.

This is not to say France is better than the United States, or that they’re always healthier than us (I’ve breathed in more cigarette smoke in the last two weeks than I probably have in the last two years in the US). I have incredible doctors in the US and have received fantastic care (shout out to my US endocrinologist who drove to my parent’s house this week to drop off paper prescriptions for my medications).

It’s just something I find interesting and fortuitously happen to be learning about currently in one of my nursing classes. (If you want to read more about this, you can look up this article: Fawcett, J., & Ellenbecker, C. H. (2015, JUNE). A proposed conceptual model of nursing and population health. Nursing Outlook, 63(3), 288-298. http://dx.doi.org/10.1016/j.outlook.2015.01.009.)

Scheduling Appointments and Finding Doctors

I’m not sure if I got lucky or the system is typically this easy to access, but I managed to get three doctors’ appointments within the first week I arrived! I sought out doctors that worked at The American Hospital in Paris, known for offering services in English (and being a little more expensive than the typical public hospital systems). I used doctolib.fr, a French website that finds available doctors based on location and specialty, to find my Endocrinologist. I was able to make this appointment online while still living in the United States. I made it about six or eight weeks in advance, and it was his first available.

I had also found a Paris OBGYN based on a recommendation from my husband’s colleague. I also made an appointment for her first available (also around the time of our arrival to Paris) through doctolib.fr. Unfortunately, this appointment was cancelled twice. The doctor’s secretary emailed me and asked me to call her (difficult, since they were six hours ahead and intermittently closed for the August holiday). Eventually I was able to talk to the secretary only to discover that the doctor couldn’t accept me as a patient because my due date conflicted with her vacation!

Luckily, another doctor had been recommended to me by a friend of a friend. Once we arrived in Paris, I easily made an appointment by emailing the office; I got an appointment for that week. Though I had been under the impression that she was an OBGYN, she was actually a Primary Physician. She then recommended an OBGYN, of which I also was able to get an appointment that week (by phone call, she was not available for a few months, but I was advised to email and explain that I needed to get in sooner… and viola! I was able to see her in three days).

We arrived at each appointment early or on time, and like clockwork, each doctor was about 45 minutes behind. Every doctor spent as much time as I needed with them, allowed me to go through all my questions, and explained things in a way I could understand. Part of this is due to my learned ability to advocate for myself as a healthcare consumer (“I don’t think I quite understood what you just said. Can you explain that?”), and part of it is because I truly believe I found great doctors. One girlfriend asked me how the quality of providers compared to those in the states, and I said, “I feel the same about them as I do any of the really good doctors I had at home.”

Communicating with Health Care Workers in Paris

Communication has been relatively easy, as long as my questions and needs continue to be routine and not urgent. Phones don’t always work (or are answered) when calling a doctor’s office. For example, I’ve never gotten ahold of my endocrinologist via phone, but he or his secretary are quick to respond to emails. I asked each of my doctors the best way to contact them if I had questions, and they all responded, “by email”.

If you do get ahold of someone on the phone, they always answer in French – and in person, people at The American Hospital in Paris also greet you in French. If you need help in English, you can simply say “Bonjour, parlez-vous anglaise?” (pronounced pah-lay-voo ung-lay) and the staff typically switch to English.

My primary doctor is originally from Canada and my OBGYN from the United States, and both speak English as their primary language. Therefore, thankfully, there were no language barriers that interfered with my care. On the other hand, my endocrinologist, originally from France, speaks English as his second language. If you’ve communicated in English to someone who primarily speaks another language, you might be familiar with the sing-songy style of talking that commences.

This was how my husband and I communicated with the endocrinologist, and it worked well 99.9% of the time. The only difficulty we had was when he recommended we send him “mail” if we needed to send him lab results or get ahold of him. We only discovered that he actually meant “email” when we talked with his secretary about how to inform him of our changing address.

Pharmacies

Pharmacies, much like Walgreens or CVS in the states, seem to have everything you need (or staff will happily order it for you). Each one varies a bit, but they tend to have everything from prescription and over the counter medications to shampoo, makeup and baby formula. There seems to be one on almost every street (they each have a big green plus sign on their front door), though their hours vary – many are closed on Sundays.

You can also purchase vaccines at pharmacies with a valid physician order. Contrary to the practices in the US, vaccines aren’t housed in medical centers. To get a vaccine (in my case, whooping cough to prepare for baby’s arrival), I received a prescription from my doctor, filled the prescription at a pharmacy, and will bring the vaccine with me to a doctor’s appointment at a later date. We have a much more convenient process in the states, especially considering the vaccine must be refrigerated until use. The vaccine cost about 40 Euros.

I haven’t been here long enough to fully appreciate the medication availability; although if a drug is not in the store but available in France, pharmacists are happy to order it for you. I discovered that vitamins, such as pre-natals, are not covered by insurance and are bought at pharmacies. I was recommended one brand, Nataliance, which reminds me of the Zahler brand I’ve used in the US. It cost 17 Euros for one month’s worth, slightly less than what I paid in the states. The pharmacy I use didn’t have it available, but they ordered it and it was available for me the next morning.

France doesn’t carry Synthroid! Who knew. I can transition to another similar drug or have my doctor back home write a paper prescription that a family member can fill for me there; they can then ship it to me or bring it when they visit, which is what I’m hoping to do.

Costs of French Health Care

I don’t yet have French insurance yet as it hasn’t kicked in from my husband’s work. So far, we’ve spent 250 Euros on the Endocrinologist appointment and 150 Euros on the primary doctor and OBGYN appointment (each). In my opinion, this is still WAY less money than we would have paid in the States, with or without insurance. Additionally, I paid 172 Euros for lab work, which included a urine sample, my diabetes screening for pregnancy, and blood work for my thyroid and pregnancy. I would have paid about the same or more in the US with insurance based on my experience.

Though we don’t have insurance yet, the hope is that we will be able to submit for reimbursement of these costs once we have it. It’s unclear if this will be possible (processes have changed recently), but we’re hopeful. Secretaries, labs, and pharmacies seem accustomed to presenting you with a “receipt for reimbursement” if you ask for one, and they will give you a form with a stamp declaring that you have indeed paid for services. It will be interesting to see what costs we incur once we have insurance.

Using Medical Labs for Blood Draws

Labs are located all over the city, much like the US. You can go to any of them to complete your lab work.

The process for getting your labs drawn relies much more on the health care consumer as it involves paper orders. If there’s anything we’ve learned so far about France, it’s that they love cheese, bread, and paperwork.

Case in point: our lease agreement for our rental was NINETY THREE PAGES LONG. 93. Ninety. Three. So, it’s no surprise that when it comes to your health care information, you typically get paper copies of important documents.

To get labs drawn, you are first given the lab orders in paper form from your doctor. Once you bring them to the lab, the lab makes copies and gives you back the original. Once your labs are resulted, they give the results to you, and you are responsible for getting the results to your doctor.

There is an exception for this. If you get your labs drawn at the same hospital where your doctors work, they can access your lab results without you sending then. This is the route I chose to take. I decided to take the Metro (train) to the hospital to get my labs drawn, rather than walking to the lab at the end of my street.

Accessing Health Care Information

Electronic Medical Records are used in France as well. However, there is not an easy interface for the patient to see these records, like there are in the US. There’s no “Open Note” law that I’ve observed so far, and to get copies of your medical records you’d need to request a CD-ROM from your doctor. I don’t receive an “After Visit Summary” like you would in the states, which (let’s be honest, are not typically super helpful – and I can say that because I’ve handed out thousands of them as a nurse) describe the next steps for the patient and a summary of their appointment. I typically summarize the appointment myself, out loud, and ask for confirmation from the doctor that I understood the plan of care.

I do miss being able to securely chat with my US doctors via MyChart (and in fact, still do on occasion to keep them updated) and to be able to see all my lab results by logging in to a website. For someone who prefers to stay kinnnddd of organized by omitting paperwork in their life (online internet/water/gas payments, etc.), I have the new challenge of organizing my medical record files physically and placing them in a safe location in the house. Time to get a filing cabinet!

Overall, I’ve been very pleased with my experiences in the health care system so far. It’s certainly comforting knowing that if something happens, I have doctors who are familiar with me and can care for me. I feel that each doctor are experts in their field, have established good rapport with me, and will take care of me. Other health care providers, such as lab personnel and pharmacists, have been friendly, knowledgeable, and eager to help. We will certainly have new adventures to report back on once we stay overnight in a hospital and give birth...but so far so good!

Do you have any questions (or advice!) for me about these experiences so far? Anything specific peak your interest? I would love to hear about it!