In January, the French government announced plans to double two healthcare expenses, the ‘franchise médicale’ and the ‘participation forfaitaire’.

Both of these are fees are deducted from the reimbursement of medical costs such as prescription charges and appointment fees, but they are applied in different circumstances.

The franchise médicale already was increased in April 2024, and the participation forfaitaire will increase starting on May 15th.

How the fees work

France’s healthcare system works on a reimbursement model – you pay the doctor, pharmacist or other medical professional up front and then some or all of the cost is reimbursed to you by the French state.

But the exact amount that you are reimbursed is worked out according to a complicated formula that takes into account your personal circumstances, the type of treatment you are having and the status of the doctor who is treating you.

You can find a full explanation of how it works HERE.

However, after the reimbursement is calculated a small amount is subtracted from the total cost – the franchise médicale and the participation forfaitaire. These costs (usually around €1) are therefore not reimbursed.

Generally, any costs that are not reimbursed by the state will be covered by the ‘top-up insurance’ known as a mutuelle, if you have one.

However the franchise médicale and the participation forfaitaire are not covered by a mutuelle either, so you pay them out of pocket.

Franchise médicale

The franchise médicale is applied to prescriptions, visits to ‘paramedical’ professionals (including appointments with nurses, physiotherapists and masseurs, speech therapists and eye specialists), and non-emergency medical transport.

On April 1st, the franchise médicale was doubled from €0.50 to €1 for prescriptions and ‘paramedical procedures’ and from €2 to €4 for patient transport.

There are also caps on the amount that can be charged in franchise médicale in one day, which increased in April.

The maximum amount that can be charged in one day in franchise médicales for paramedical appointments rose to €4, instead of €2 previously. Meanwhile, for medical transport, the maximum went up to €8 in one day, instead of €4 previously.

There is currently a cap of €50 on the total amount you can pay in franchise médicales per year. This will remain in place despite the increased charges, according to the French government site Service-Public.

Does everyone have to pay this?

Some groups do not have to pay franchises médicales;

• children under the age of 18;
• beneficiaries of complementary health insurance (Complémentaire santé solidaire) or state medical aid (Aide Médicale de l’Etat – AME)
• pregnant women from the first day of the sixth month of pregnancy until the 12th day after giving birth;
• minors purchasing contraception and/or the morning-after-pill without parental consent;
• victims of terrorism

What about the participation forfaitaire?

This is the same principle as the franchise médicale, but is applied to different types of healthcare –  specifically any appointment with or procedure carried out by a general practitioner or specialist, as well as X-Rays, scans and lab tests.

Previously, it was set to a flat rate of €1 across the board. However, starting on May 15, 2024, it will increase – the exact amount is still to be clarified, but it will not be more than €3, according to the government decree.

Like the franchise médicale, there will be a €50 annual cap on costs.

How does this work?

As with the franchise médicale, you will pay the same price for appointments and treatments, but the reimbursement will be slightly less.

Let’s take as an example an appointment with a GP who is ‘sector one’ – the standard charging rate for GPs – which are reimbursed at 70 percent.

Assuming that the new charge is €2, you would pay the standard appointment fee of €26.50 and will be reimbursed at €16.55 – 70 percent of the €26.50 (€18.55) minus €2.

If you have a mutuelle, it would cover €7.95, leaving you to pay €2. 

How does it work in practice?

You will continue to pay the same price for prescriptions, appointments and transport, but the reimbursement amount you receive will be slightly less.

So let’s take a prescription as an example; you pay the pharmacist €10 for a box of tablets that have a reimbursement rate of 65 percent – you will be reimbursed €5.50 (65 percent of €10 is €6.50, minus €1 franchise médicale equals €5.50). 

If you have a full-cover mutuelle, you will receive €3.50 from the mutuelle, leaving you to pay €1.

Why raise rates?

The French healthcare system is currently in deficit and the government is hoping that the charges will allow it to raise additional funds – although the vast majority of healthcare funding continues to come from the public purse, via taxes and social charges.

According to RTL, increasing these charges will allow the state to add take in about €800,000 million in funding.