Last week my blogging consœur Victoria Ferauge—a fellow longtime American resident of France—published a post on her fine blog of an experience she recently had with the emergency room of a French hospital, and in which she made some comparisons between the French and American health care systems. As it happens, I also had an experience with the ER recently, my first ever in France (and only the second in my life, the last in the mid 1980s). Exactly three weeks ago, during the season’s first major snowfall in Paris, I was walking home in the early evening carrying groceries, slipped on the very slippery sidewalk, and fell, and with my foot twisting around in the process. I was in great pain, it was dark, and there was no one around. Fortunately a couple of good Samaritans did see me and came to help. My apartment building was within sight and my wife was fortunately home, so she came with a neighbor to meet me. As I couldn’t walk—I had badly messed up my ankle—, the snow was falling heavily, and I clearly needed to get to a hospital, she called the SAMU. Within fifteen minutes or so an ambulance van of the sapeurs-pompiers (fire brigade) arrived and took me to the ER of a nearby hospital. While in the van a fireman asked for an ID card so he could fill out a form. At the ER the firemen waited with me until a member of the hospital staff came to take charge. They were nice, helpful, and, not surprisingly, professional.
I thought I’d be in the ER for several hours but was tended to fairly quickly, even though the place was full. The X-ray of the ankle showed a fracture, so it had to be put in a cast. The doctor (from the Congo-Kinshasa; hospitals in France would have significant personnel shortages were it not for immigrant staff) wrote prescriptions for paracetamol (which is sold over the counter but if one has a prescription it’s covered by insurance), five weeks worth of anticoagulant injections to be administered daily, and crutches (cannes anglaises). He also gave me the number of a private clinic around the corner from my place and told me to schedule an appointment with an orthopedic specialist there ASAP. I was then told I could go home. There was no discharge process and no one asked for insurance information. The fireman no doubt gave the hospital a copy of the form that had been filled out in the van, but all that contained was my name, address, and DoB. My wife, who doesn’t drive, was fortunately able to get friends who live nearby to traverse the snow-covered streets and and pick me up. I was in and out of the hospital in two-and-a-half hours.
As the temperature remained below freezing for several days I couldn’t venture outside on the icy sidewalks, so the appointment with the orthopedist at the clinic didn’t happen until eight days after the accident. He said more X-rays would have to be taken to determine the seriousness of the injury. The new X-rays indeed showed the injury to be worse than that what the original had indicated, thus necessitating an urgent surgical intervention. So the operation took place and I spent two not particularly pleasant nights in the clinic (it was only the second overnight hospital stay of my life, the previous one 38½ years ago, following an operation on the very same ankle, injured while playing basketball). I was discharged a week ago today and with a new cast on. As this was a private clinic there was paperwork and for which my Carte Vitale and carte de mutuelle were needed. Had I not had these—i.e. if I weren’t covered by the Sécu (which everyone legally living in France is) and didn’t have a mutuelle (which 90+% of the population does)—, I would have received a sizable bill from the clinic. But I won’t be receiving any such bill. I did have to write checks to the orthopedist and anesthesiologist for a total of €180 but some or most of this will be reimbursed by the Sécu and mutuelle after I submit the feuille de soins (my doctors are in private practice—though are conventionné, i.e. registered with the Sécu—and basically set their own fees). As for the prescriptions, the only one so far for which money has had to be forked over was the crutches (€29). The registered nurse who comes daily to administer the anticoagulant shots and take twice-weekly blood tests—a team of three infirmières à domicile, who work out of a neighborhood paramedical clinic that does house calls—is also conventionné, though I’ll have a write a check of around €100 for the service when the process is finished (though that should be mostly or entirely reimbursed by my mutuelle).
So now I find myself at home and with a cast on my lower right leg for another five weeks to go, and with instructions from the doctor not to put any pressure on the leg (i.e. absolutely not to walk on the cast, even lightly). Which, in effect, means that I cannot go outside until I see the doctor again in mid-March. I suppose I could try but I doubt I’d get very far walking on two crutches outside (getting down the four flights of stairs in my building would be tough enough and my wife wouldn’t allow it anyway). I have a prescription to rent a wheelchair—which can be done from selected pharmacies—in case I really need to go out, but haven’t yet done so. So I get around the apartment on the crutches but that’s it. In terms of work, I have an arrêt de travail—which would enable me to receive 100% sick pay—but as I teach university-level courses I didn’t want to invoke it. So I have arranged to teach my classes via Skype, which is working okay so far. It’s not perfect and there are occasional technical glitches but it’s the only solution I have. Thank God for technology.
Being housebound, semi-crippled, and unable to do much of anything apart from sit at my computer, read, or watch TV—I can manage in the kitchen but can’t do any real cooking, and can’t carry anything that won’t go in a backpack—is a bummer but I’m not feeling sorry for myself. Far worse things have happened to many people in the course of human history, including friends of mine and close family members. And it’s only for a few weeks. I think about the good fortune I have had in this happening to me close to home and as a citizen of a rich country with national health insurance. I’ve been thinking about such an injury happening to, e.g., a poor person in a poor country, to a Syrian refugee in a freezing camp in Jordan, or to someone in America without health insurance (and even with insurance, of the deductibles and other fees into the four figures, maybe even more; an American friend here joked that the ambulance in the US would have probably asked for my credit card rather than ID). But, above all, I think of the good fortune I have in having my wife and daughter (age 19). I don’t know what I would do without my family right now. My condition imposes burdens on them but they’re responding with good cheer. I would really be up the creek if I lived alone and didn’t have family nearby. I would dread the prospect of living alone at my age whatever the case, but a debilitating injury or medical condition adds an additional dimension to such a prospect. So, yes, I think my fortune is pretty good.
On comparing the French and American health care systems, my mother (age 82) wrote an account of an experience she had some four years ago when she came to visit me, and that was published as a guest post on the blog of a health policy specialist at Duke University.
Its nice once you’re in the system. I have lived legally in france coming up on four years a a student and now working. Have been to the sécu dozens of times and have sent the same amount of letters to my student mutuelle without ever getting a carte vitale or a cent reimbursed, all the while paying over 300 a year to the sécu and mutuelle. It is only with the weight of a big 4 accounting form behind me that I am on track, six months after beginning to work, to get a carte vitale in the next few months. Im not at all defending the us, but I had one minor medical bill here, about 1 000 that i paid out of pocket at the american Hospital. I got in touch with my us insurers very responsive reps and was reimbursed immediately.
shartka: I can’t speak to your specific case except to say that once one is in the system and has the Carte Vitale and a good mutuelle – some mutuelles not being good-, things work fairly smoothly, and with prompt reimbursements from the Sécu. A couple of points. First, the student mutuelles are notorious for slow reimbursements and inadequate coverage. It’s an ongoing scandal and that has been amply aired in the press (see, e.g., Le Monde of 28 Dec. 2012). Secondly, the American Hospital in Neuilly is outrageously expensive. I can’t imagine why anyone would go there (except maybe if one needs English-speaking doctors and personnel).
Thanks for sharing your experience. Hard to be cooped up – one becomes stir crazy after a while – but you have the right sense of perspective. A small bump in the journey of life.
Andrew: I haven’t gone stir crazy yet but, with another month to go, don’t know how long I’ll hold out. I suppose I should be thankful this happened in the dead of winter. It would be tough if the weather were nice and everyone else were outside having fun…
Spring and mobility should arrive together!
when i tell my american family and friends my medical experiences they find it hard to believe that so much is done for you. several years ago there was a five day weekend and on the first day i woke up with a pain in my chest but was not overly alarmed as there was no accompanying pain in my arm. after piddling around for 3 hours i called the emergency number, had the SAMU at my house 10 minutes later. they quickly called the hospital (an hour away) and a half hour later a helicopter landed in the adjoining field. after much palaver between the doctor and the hospital i was airlifted to the hospital, where i stayed for two days in cardiac intensive care until someone senior arrived on the friday, said my heart was fine but something was wrong somewhere. ultimately it turned out to be my gall bladder that was removed and i spent a week in hospital. my only complaint about french hospitals is that they don’t see the necessity for privacy curtains in rooms with more than one patient, but the entire adventure cost me not a penny. had this been a programmed intervention i could have had a private room for – if i remember correctly – somewhere between 15 and 20 euros per day.
Joel: Interesting you mention the lack of partitions in shared hospital rooms. I had the same thought when I was in a shared room in the clinic last week. Fortunately my roommates were ambulatory and didn’t spend the night. As for the cost of a private room, it was €125, which is why I didn’t request it.
Sad to hear what happened to you ! All my positive vibrations for a solid recovery. I experienced such a stupid bad fall 10 years ago during a walk with friends in the Alpilles near St Remy de Provence. My foot got caught between two stomes and I fell forward…. I heard the scary “craccc” and knew instantly that I had badly f….. up my ankle (later my “medecin généraliste” watching the X rays, said : “you must have walked on a mine!”). I was taken to an unknown hospital in Avignon. The local orthopedist surgeon fixed my ankle the next day with 24 screws and 2 metal plates and put an orthese (orthopedic brace) around my leg but no cast. Then I was put in an ambulance and on a plane with brand new crutches and sent back to Paris where I lived at the time (transfer 100% covered by the insurance that goes with my Visa Premier since I baught my Tgv ticket with it !) I lived on the 5th floor with no elevator then. I was 56 years old. My wife was gone for 6 weeks in India. Good for her ! I didn’t tell her anything on the phone (Why ?). The Monoprix was 300 meters away. I did manage. Went up and down on my ass using my other leg to prop me up. Later, I started the kine sessions with a very good kine (that’s key). But what truly saved my anckle was the staircase. People tend to over “spare” a wounded arm or leg, they become scared to use it and overprotective, this is wrong ! One must be careful of course, but hard willing to recover 100%. And you can do it. You know, with a Yes I can kind of attitude. A soon as I was allowed to put my foot down, I started going up and down those flights of stairs at least 2 or 3 times a day, sometimes more. Then I resumed going around with my bicycle. Excellent for anckle. 10 years later, my right anckle is and looks bigger than the left, but it is acceptable, and I can do whatever I want. No pain when it rains, no limping at all. I can walk in the hills for hours in regular mountain shoes, I can ski… And yes, all of that was covered by la “sécu” and my mutuelle. Doulce France…. All the best.
Massilian: That’s quite a story! And an inspiration, insofar as your ankle seems to have recovered 100%. Your injury sounds worse than mine, though it’s hard to say. What made mine serious was that the ankle was knocked out of the joint and with ligament damage. One plate was put in but no screws, so said the orthopedic surgeon. If the ankle does get back to normal you can bet that I won’t be doing any skiing (not that I’ve ever skied in my life…). But walks in the hills, yes.
I realize I went epic with the number of screws, I checked, it was 18 not 24…. It was a double fracture with displacement, both malleoles gone, with a dislocation of the astragale bone as a bonus. I couldn’t believe it. I was walking, talking to my friend’s wife, I bumped my foot on a stone, couldn’t lift it for some reason, couldn’t even get it out of the shoe ! So I fell heavily because it was so unexpected… Usually I fall gracefully… I mean in motorcycle accidents…(I never hurted myself as badly as in this stupid fall !). What you discribe to me, leads me to stress even more the importance of the choice of your kine. I advise you to spend some time checking the Methode Mezières and checking if you can find one Mezieriste kine near your place (http://methode-mezieres.fr/praticiens.html). To me they are the most enlightened of kine and very good at drainage lymphatique which I believe can help a lot with ligament damage. A good Mezieriste could bring you a significant difference in your recovery, timewise and in quality and confidence. By the way, this is not a sect ! Talk to one, see how you react.
You’ll walk in the hills for sure. I’m back from the mountain, looking at the ski shoes, I don’t see how you could possibly hurt your ankle in these shoes. You leg will snap or your knee will be history, but your anckle, unless a snowplow runs over it… it will be safe.
I feel for you, Arun. I had the same mishap 18 month ago (never ever go down an unlit cellar stair, narrow and encumbered while carrying stuff). I didn’t take it seriously, thinking it was just a bruise and would pass, but luckily I had to go to a routine medical examination, my “généraliste” noticed my swelled ankle and told me to get an X-ray. I thought she was being over-cautious, but went for it at the neighbouring “clinique conventionnée”, where they x-rayed my ankle and the doc simply kidnapped me, telling me I must remain in the clinic and have an operation right away! I begged for a reprieve, as I was busy the next few days, and would at least liked to go fetch from home a toothbrush, night clothes, a book, etc… He didn’t relent (my husband kindly brought me all this later). Well the clinic was pleasant for two or three days, the surgeon was lovely (should I
Perrine: Yes indeed, never walk in an unlit space anywhere. I have had more than one near fall walking on a darkened street with inadequate lighting, particularly in African cities. E.g. in Bamako a number of years ago I ventured out of my hotel to go to a restaurant for dinner. The walk back to the hotel through the near pitch black streets was one of the most treacherous I have ever had: one gaping hole and casse-gueule after another on the sidewalk. I would rather not think of the medical attention I would have received there in the event of injury to my ankle.
Arun, So sorry to hear about your mishap but glad to hear that French healthcare once again came through. Tough to be housebound (believe me I know 🙂 And thank you for the link to and your kind words about the Flophouse.
I’ve been talking to one of my fellow bloggers (a Frenchman living in my hometown of Seattle) and we’ve been comparing our experiences (he has leukemia and I have breast cancer). We are both getting great care but I pay nothing while he is being billed around 12,000 USD per year in co-pays (he was insured through his work and now through his wife who is a professor at the University of Washington). And for the cherry on the cake, his company (he’s also an IT guy) fired him last year. They got tired of waiting for him to get well. My friends back home in the U.S. found that sad but understandable. I on the other hand was deeply shocked by this. You can read more on his blog here: http://www.carnetsdeseattle.fr/2012/04/licencie-i.html
Victoria: These stories from the US are indeed shocking. $12K in annual co-pays is unbelievable for someone with presumably good insurance coverage. I suppose this is affordable for people at the very top of the income scale but for the vast majority – including me – the burden would be onerous to bankrupting.
Sorry to hear about your leg. All best wishes for a quick recovery! Now you have time to watch French tv (hum…) or read all those books you never had time to read!
As to differences in medical and insurance systems, i couldn’t tell you about the French one, but in Finland things are ok. I have been mostly using services for children, and those have been affordable and efficient.
I would imagine that the care in Finland and elsewhere in (northern) Europe is as good as in France and with similar out of pocket costs (minimal). The French system is, in fact, more expensive than others in Europe (or Canada), in terms of the rapport qualité-prix. A lot of it has to do with the high percentage of doctors in private practice (médicine libérale) and who know how to defend their interests. Medicine in France is far less “socialized” than Americans may think.
Pretty much as you said. The public system here is efficient, easily available, and largely costless. However, its efficiency and availability depends a lot on where you live. Some regions of the North and East are immense “medical deserts”, with most services gathered in towns, and especially in the South and on the Western cost – to be fair, most of the population lives there too. There are also small hospitals and health centers in small burgs where I would not like to give birth or get heart surgery… But if you live in a big town, health services are available and affordable.
Arun: I’ve only just now read of your misfortune. You’re now closer to the end of your ordeal than the beginning. I hope your recovery continues to go well. You have my best wishes.
dojero: thanks, I appreciate it.
[…] my own out-of-pocket health care costs over the past two months—related to my recent mishap—, they so far add up to €470. This is the total amount I’ve had to write checks for. A […]