Let me make it clear from the outset that I know I’m not comparing apples with apples, this is my personal comparative view and is not a criticism of either system.
Since coming to France I have been really well cared for by my GP, my nurses and the ‘local’ hospitals. I put local in parentheses because the nearest hospital is in Aubusson, a 30 minute drive away. When I had my accident my right shoulder was smashed and the right arm was broken just below where the arm and shoulder meet and the hospital where all this is due to get fixed is in Clermont-Ferrand, which is a good 80 km away, a 90 minute drive. When I’ve had the surgery I will then be moved to Aubusson for 4 – 6 weeks of rehabilitation, so Karen has the prospect of anything between 1 or 3 hours driving to visit me for 6 weeks or so. The joys of country living or what?
Both hospitals are small when compared with a typical NHS hospital but do not suffer from any lack of investment. The Hopital prive La Chataignerie at Clermont-Ferrand is well organised, modern and has a Da Vinci robot operating gizmo that looks really space-age. The web site lists all the Doctors and their phone numbers, so they don’t hide themselves away and from my experience they all seem young but highly competent. The Centre Hospitalier runs at 2 sites in Aubusson – Croix Blanche and Le Mont. Croix Blanche has the A&E amongst other things. Karen is now under the care of the French breast screening programme and was impressed by the way her appointment at Croix Blanche all happened to time and by the way that she was looked after. The radiologist she saw gave her the OK there and then but advised that the results would be sent to a senior team for peer checking. That result came back clear within a week or so – the system works well and quickly and the whole experience put Karen’s mind at rest. When I’ve had my surgery I’ll go to Le Mont to the SSR Unit – which will be like going back to Stanmore – but more modern – check the link!
So allow me to walk you through the processes that have got me to where I am currently: We called our GP – Dr. Chanson – and he popped in one evening after completing his daily house calls to discuss my arm and our options (fortunately he lives a 5 minute drive away in the next hamlet, so getting to see him isn’t a problem, he calls in after his lunch or before his dinner – perfect!) Dr. Chanson recommended a surgeon and a few days later called to advise the day and date of our appointment and give us a prescription (ordonnance to the French) to see Dr. Lecomte at La Chataignerie. On the due day we turned up, spoke with a receptionist, handed her my Carte Vitale and plugged my Visa card in the machine to pay.
Carte Vitale – what’s that I hear you say? Let’s digress for a moment or two. At the moment, because I pay National Insurance contributions in the UK, I am entitled to reciprocal healthcare i.e. I pay whatever a French person pays and can claim back any extra expense from the UK. Except I can’t, because you can only claim back if you are in the UK. We aren’t, and because I’m not a crook I won’t ask someone in the UK to help process claims for me and pretend I’m living at their address. Instead, I have registered with the French Social Security bureau and taken out personal health insurance, as is the way here. To be registered with the French Social Security and get that all important Social Security Number and Carte Vitale involves dealing with Her Majesty’s Revenue and Customs to get a Form S1 that confirms your income (if you aren’t working in France) and NI contribution payments, which you then send to the local CPAM office. It only took a couple of weeks for the French end to come up trumps but managing HMRC’s web portal was awful so I ended up downloading a form, printing it off, filling it in and posting it back to the UK – it took weeks to come back! And guess what? I’ll have to do that annually – but what will happen when my sick pay ends and I’m on my pension because you don’t pay NI on a pension? That will take some research and I’ll let you know when I find the answer.
Back to the story and already you might have noticed that I have incurred 2 charges – the visit of Dr, Chanson to start the ball rolling and then the visit to Dr. Lecomte. Dr. Lecomte listened and questioned me about the why’s and wherefores’ (but didn’t write anything down) and then gave us an ordonnance to get a scan to show my bone density, an x-ray and a nerve block injection to give me some pain relief. He advised us that any decision to proceed would need to be supported by the results of the pictures. We made appointments for all this work to be completed on the same afternoon a few weeks later to save us the travelling and happily left, thinking job well done. When we arrived for the photos we were told that we’d missed an appointment a week earlier! Unfortunately for them Karen’s fluent French wasn’t going to let that go by unchallenged and the receptionist was soon put straight about who had made the mistake – although we had to take an appointment the next day for an x-ray as they were booked solid, which scuppered the attempt to try to minimise the travel. So off downstairs I went for a scan and a jab, which all happened smoothly and painlessly. The staff were attentive, well practised and the equipment was as up to date as you could expect – even the IT equipment shone – all Mac’s, all new and not an NHS style Windows XP PC in sight! Just a thought while I’m on IT – now we know the truth about Carillion and other PFI contracts was the plethora of XP in the NHS that allowed the ransomware outbreak last year down to PFI suppliers ‘working to contract’? As my old chum Andie Grant would say – just asking?
I’m now up to 5 charges, 1 each extra for a scan, an x-ray and an injection on top of the earlier 2.
We then had to see Dr. Lecomte again and he said the operation was good to go, subject to me getting the all clear from a heart consultant (cardiologue) and an anaesthetist (anesthesiest) to make sure my old body was fit for further surgery and handed me another ordonnance for the cardiologue. The anesthesiest didn’t need an ordonnance because I was now in the system and had to see 1 there. The day was getting late so we left and booked the appointment for the gas-man online when we got home – which was amazingly easy – we were offered a selection of days and times and just took our pick. An e-mail back to us confirmed the appointment and that was that. We’ve been to see the gas-man and he’s OK about things but ideally we should have seen the heart man first. Unfortunately there is only 1 – yes 1 – cardiologue in the whole of Creuse. Creuse has a population of something like 120,000 and covers an area of 5,565 sq, km – 22 people per sq. km. (compare that with Greater Manchester’s 2,700,000 people crammed into 1,277 sq. km) but only 1 cardiologue, and he’s retiring in June this year. This highlights a problem that affects all healthcare professions in rural France – there aren’t enough of them and those there are coming out of training don’t want to work in the countryside. Fortunately he’s in Aubusson and I’m of to see him early in February but even that’s not proving simple – his office (cabinet) is up 2 flights of stairs – and there’s no lift – so even if I wasn’t in a wheelchair but my ticker was tocked, getting to see him might be all that was needed to see me of this mortal coil! Seeing this bloke means an early start – up and out by 08:00 but hopefully he’ll give me the all clear and I’ll be good to go.
And that’s now at 7 charges – Dr. Lecomte (again) and the anesthesie Dr. Cristophe. By my reckoning I’m now running at a cost of about 250€ with another 50 or 60€ to come for the cardio – and that’s before the cost of the operation, operating theatre costs, drugs and then the room hire (for 6 weeks remember). Is this beginning to scare you? It sure is me but all is not as bad as it seems. I mentioned earlier in this piece that we’ve taken out health insurance – it’s expensive on the face of things but not so bad when compared with NI contributions back in the UK. I have a Carte Vitale so the French system pays a percentage of my medical costs and I cover the rest, either straight out of my pocket or through my insurance. The cost of the insurance is determined by the amount you want them to cover for you but it usually splits 3 ways, a third each. Because I am paraplegic I get a 100% reimbursement for my nurses, drugs and catheters and because my Carte Vitale links directly to the system no money changes hands – it is, to all intents and purposes free at the point of use, the fundamental principle of the NHS. It’s when things get more complicated that costs can mount up, but I’ll cover all of this in more detail as my costs mount.
Well that’s all for today. More soon.
Jem