An Interpretation of Medical Insurance System for French Immigrants

# French immigrants # Introduction People often say that France is a western capitalist country with a "socialist" color. This kind of "socialism" is a social insurance system with high welfare and multiple guarantees that everyone can enjoy. French social security system has gradually formed a set of social insurance system (Sécuritésociale) with wide coverage, deep social security content and perfect procedures after more than 100 years of evolution and development since the first legal provision on compensation for industrial accidents was promulgated in April 1898.

It is often said that France is a western capitalist country with the color of "socialism". This kind of "socialism" is a social insurance system with high welfare and multiple guarantees that everyone can enjoy. French social security system has gradually formed a set of social insurance system (Sécuritésociale) with wide coverage, deep social security content and perfect procedures after more than 100 years of evolution and development since the first legal provision on compensation for industrial accidents was promulgated in April 1898.

Judging from the content of insurance services provided, it mainly includes three aspects: medical treatment for diseases (maternity, disability, death, work-related injuries, occupational diseases, etc. ), pension and family allowance. Among them, sickness medical insurance benefits the most, and even international students studying in France benefit a lot. "Everyone has the right to receive medical treatment" has long been a social principle and knowledge. The welfare system of "the widowed, the widowed and the disabled are provided for" is as proud as the spirit of "freedom, equality and fraternity", and it also forms a special social security model in France.

Medical insurance has a wide audience.

The French medical insurance system for diseases was established in 1945. Today, the insurance covers most of the people's medical needs and is known as one of the most generous medical insurance systems in the world. According to the income mode of the insured, the people who participate in medical insurance include the working class (that is, employees who receive wages from the employer); Freelancers (including craftsmen, businessmen, artists, agricultural operators and clergy, etc.). ); Those who have no income from professional activities (including the unemployed, retirees, students, housewives, prisoners, etc.). In addition, this principle also applies to all foreigners legally residing in France, even those who have no legal status can obtain relevant medical services under certain conditions. It can be seen that medical insurance in France belongs to the basic social welfare security system for all, and the compulsory collection of insurance premiums by the government also ensures the universality of everyone's participation.

For the working class, the medical insurance premium of employees accounts for about 19.6% of the total wages, which is shared by enterprises and employees in proportion. Usually 6.8% is deducted from the total wages of employees, and the rest is paid by enterprises. Freelancers pay medical insurance premiums according to their income, while people without income can enjoy medical insurance by paying little or no insurance premiums. For example, college students can get basic medical insurance services by paying about 190 euros a year. Unemployed people can apply for free CMU.

High reimbursement guarantee for medical treatment

Generally speaking, sickness medical insurance refers to the basic medical insurance enjoyed by the whole people. In addition, the association also provides various voluntary mutual insurance services. The latter is a kind of supplementary insurance, which mainly fills the expenses that cannot be reimbursed by basic medical insurance. According to the medical insurance regulations, 70% of the insured's medical expenses are reimbursed by the basic medical insurance, and the remaining 30% belong to patients' self-care expenses. If you participate in mutual insurance at the same time, the part borne by the individual can be reimbursed again or even completely. This multi-level and complementary medical insurance service will eventually form a medical insurance network covering the whole people.

In 2004, the French government reformed medical insurance and formulated a series of new regulations. Only when the insured strictly abides by the regulations can he fully enjoy the insurance service. The new regulations require each policyholder to choose a "medical insurer" for himself first, which is similar to the role of "family doctor". Every time the insured sees a doctor, he must first make a preliminary diagnosis by the attending doctor. If further treatment is needed, he should see an expert on the advice of the attending doctor. In addition, the patient's medical summary report and medical files are also written and managed by the attending doctor. The government hopes to guide doctors to help patients combine diagnostic resources reasonably and efficiently, especially to ensure that they can provide medical services to patients at the first time and reduce the blind behavior of "rushing to see a doctor". Of course, there are exceptions, such as seeing ophthalmology, dentistry, gynecology, chronic diseases or emergency under special circumstances. Patients can directly contact for treatment without attending doctors. On the other hand, patients will not be reimbursed for not following the medical insurance process.

Although the procedures for seeing a doctor are complicated, it is gratifying for patients that most of the treatment expenses, medicine expenses and even hospitalization expenses can be reimbursed at a high level. The spirit of equality, fraternity, mutual assistance and unity advocated by France is fully reflected in the medical insurance system. The more intractable and serious diseases, the more the insured can enjoy nearly 100% medical reimbursement. Vulnerable groups who have difficulties in living and receive social assistance can even get free medical care.

First of all, the treatment fee is related to the doctor the insured sees. According to the agreement signed between doctors and social security institutions, doctors have different identities and different standards of consultation fees, which in turn affects the right to reimbursement. The first agreement doctor, that is, charging patients a unified fixed medical fee; The second kind of agreement doctors can "moderately increase" the charging standard on the basis of fixed consultation fees; The third kind of non-agreement doctors are completely free to decide the consultation fees, and patients get very little reimbursement in medical insurance institutions. Therefore, it is a very important consideration to choose the right doctor and pay equal attention to treatment and reimbursement. According to the regulations, non-agreement doctors must show the prices of various consultation fees to patients before treatment. For the first two types of medical treatment, 70% of the consultation fee can be reimbursed through universal medical insurance, and the rest can be reimbursed through supplementary medical insurance or borne by the patients themselves.

Secondly, all kinds of inspection expenses, such as laboratory tests, filming and issuing reports, can be reimbursed in the basic medical insurance and supplementary insurance. Then, the drugs are reimbursed. Based on the principle of giving priority to serious diseases and expensive drugs, the French medical management department should reimburse 65%~ 100% for drugs used for major diseases or diseases that lack effective treatment methods and have obvious advantages compared with substitutes. For example, drugs used to treat cancer, leukemia, AIDS and other serious diseases can be reimbursed by 100% in basic medical insurance; 35% ~ 65% will be reimbursed for drugs that treat serious diseases, have certain application value or have advantages over alternative drugs, such as drugs for diabetes, which can be reimbursed for 65%; Finally, drugs for common diseases and standing drugs are generally reimbursed by 35%, or even not. The price of such drugs is also low, and most of them are over-the-counter drugs.

Finally, the reimbursement of hospitalization expenses. French medical insurance for diseases stipulates that in public hospitals or private hospitals with medical insurance agreements, 80% of hospitalization expenses are paid directly by social insurance centers; In private clinics that have not signed a medical insurance agreement, patients need to pay all the expenses first, and then transmit the relevant medical materials to the social security center for partial reimbursement; During hospitalization, meals and extra nursing expenses should be borne by themselves, but the transportation expenses for escorting patients to the hospital can be reimbursed by 65%. In addition, when some serious diseases or chronic diseases such as cancer, AIDS, hypertension or other genetic diseases are hospitalized, the social security center can reimburse all related medical expenses. This shows that France's universal basic medical security system is more caring and caring for seriously ill people.

As for reimbursement procedures, the French government is also trying to simplify the relevant procedures. In June of 200 1 year, an electronic medical card-Carte Vitale began to enter people's lives. This kind of electronic card for storing personal medical insurance information greatly improves the efficiency of people's payment and reimbursement for medical treatment. With it, pharmacies don't even have to pay cash for drugs and hospitalization procedures, and hospitals and social security centers handle reimbursement expenses in time through information receiving networks. Undoubtedly, the social medical insurance card has become another important "credit card" carried by the French.