In France, a “Costly” Doctor’s Appointment Is Actually Free

An American in Paris crunches the numbers.
Jan. 27 2014 11:52 PM

$200 Minus $200

Having a baby in Paris gave me a crash course in socialized medicine—and a new, very French definition of “costly.”

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In full—except for the costs of a private clinic if you’ve missed out on a public ward. There are plenty of private maternités in Paris, and I found a great one, with an English-speaking midwife who agreed to follow my pregnancy from the outset, as I still had no regular doctor. But how expensive would it be?

Luckily, transparency in the price of medical care is a legal requirement in France. The government sets what they consider fair prices for all appointments and procedures, and then reimburses these for everyone at 70 percent. This is not unlike Medicare and Medicaid in the U.S., but because the French government system covers the entire population, it has more bargaining power to keep prices low. For example, a private appointment with a midwife is calculated at a base cost of 28 euros—the same price it would be at a public clinic or hospital. The government will reimburse the patient 18.50 euros of this, even if the midwife charges more; the rest the patient pays out of pocket and/or has covered by a mutuelle.

It’s not uncommon in the bigger cities, particularly in Paris, for a doctor to charge more than the government’s recommended price. But these overages, called dépassements, don’t come anywhere near what an American specialist might charge. In fact, under French law, a doctor must issue a receipt explaining any dépassement above 70 euros before beginning the test or appointment. (France is also arguably more creative than U.S. health care providers in keeping childbirth costs down. For example, women who are likely to have complication-free births are usually referred to a Level 1 maternity ward, which has an operating room in case a C-section is necessary but no neo-natal unit or full hospital facility attached to the clinic. In the U.S., most women deliver at a full-service hospital, even if it’s likely they will experience no complications.)

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Not only was I getting accustomed to a radically different idea of what constitutes “expensive,” but I was also adjusting to the outlandish notion that I would know the exact cost of my health care services before buying them.

In the U.S., meanwhile, it’s often impossible to get a price for a delivery out of a hospital. Estimates vary by orders of magnitude: This California study of 100,000 complication-free deliveries showed that new mothers were charged anywhere from $3,296 to $37,227, with no clear medical reason for the massive discrepancy.

By contrast, for my complication-free delivery and five-day stay in a private clinic, my total out-of-pocket cost was 400 euros, or about $542.

Last fall, I watched the rollout of the Affordable Care Act with great interest from across the Atlantic. I’m self-employed, and I’m just not sure how my husband and I would have been able to pay our medical bills under the old system if we’d stayed in the U.S. The ACA is an improvement, but I don’t think we should count Obamacare’s average monthly premium of $328 as a success. That’s still a lot of money for a middle-class family—and that’s before co-pays, in-network deductibles, and all manner of hidden costs. From my French-ified perspective, a single-payer system—with strong government oversight to keep the price of medical care low—seems like the only way to go.

A final note: If you have a baby in France, expect to bring your own towels to the hospital. While there are no $10 aspirins, there’s not much in the way of other amenities, either. But for great, affordable health care, I’m just fine with bringing my own shampoo.

Claire Lundberg is a writer, literary scout, and former New Yorker now living in Paris.

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