Everyone with a carte Vitale must choose a primary doctor, or a médecin traitant or be reimbursed at a lower rate, or possibly not at all in the case of visits to a specialist without a referral.

The requirement is new as of January 2006, one of the most visible and significant of a package of reforms passed in 2004. If you're covered under French Social Security, the process is relatively simple.

Before and after

Until this law kicked in, anyone covered by French Social Security could go to any doctor at any time.

The system had the virtue of simplicity, but encouraged abuse by letting patients consult with several doctors at a time without any coordination of treatment, prescriptions, etcetera.

The new law is intended to reduce costs by requiring patients to pick a primary doctor whose responsibility is three-fold: to draft a plan, parcours de soin, for a patient's treatment, both preventative and curative; to maintain records of that treatment; and to refer the patient to specialists as needed.

As of the end of December 2005, roughly 34 million people had already picked their primary doctor; almost all of the chosen doctors are general practitioners, although this is not a requirement.

As of now, everyone is supposed to have filled out a form naming their médecin traitant to continue to continue to be reimbursed at the normal 70 percent level; EUR 1 of every reimbursement payment is also now set aside as a kind of national health tax, with a cap of EUR 50 per person annually. (This means your reimbursement payments should equal 70 percent minus EUR 1.) Woman pregnant beyond the six month and children under 18 are exempt from this EUR 1 tax.

Anyone who does not signed up with a primary doctor is eligible for only 60 percent reimbursement (minus EUR 1); but, watch out, you may not be reimbursed at all by either Social Security or even private insurance for treatment by a specialist without a referral.

Any treatment by a specialist, médecin correspondant, must be coordinated by your primary doctor. While the floor for an office consultation with your primary doctor is still EUR 20, this increases to EUR 27 for a médecin correspondant, but this will still be reimbursed at normal levels if you have a referral.

A hospital visit now costs EUR 15 a day (up from EUR 14 in 2005) or EUR 10 a day in a psychiatric facility; expect this figure to go up by another EUR 1 day in 2007.

The exceptions

There are some cases when it's permissible to skip the call to your primary doctor:

• for emergency medical care either at home or while travelling
• when you're travelling in France or abroad or your primary doctor is unavailable (on vacation, for example)
• an appointment with a gynaecologist, ophthalmologist, psychiatrist, neuropsychiatrist, neurologist or dentist. These doctors can refer your records back to your primary doctor, but only with your consent.
• parents do not need to fill out forms for children under 16

The paperwork

If you still need to take care of this, first you must pick a doctor, any doctor, as long as he or she is conventionné, which refers to a kind of licensing system that doctors voluntarily enter into with the state. Most doctors have signed a convention, but it's worth asking the question if you want a non-general practitioner as your primary doctor.

The form you need is S3704, which you can download from the Assurance Maladie en Ligne website. It must be signed by both you and your doctor and submitted to your local CPAM office.

For the time being at least, this change does not involve trading in your carte Vitale; your records will automatically be updated after the form is processed.

Next up: the new carte Vitale

With the primary doctor system instituted as the first step in a more general reform, the next phase will start mid-2007 with the creation of dossier médical personnelle.

Your carte Vitale is already used to track all of your medical expenses, but the personalised medical record will go the next step to creating an electronic medical history documenting all of your conditions, allergies, prescriptions, tests, etcetera.

Since the key to accessing all this information will be, again, the carte Vitale, there has been much concern about possible invasions of privacy; to address these concerns, next year you'll be asked to obtain a new, ostensibly more secure version of the carte Vitale.

Your medical history will not actually be stored on the card but in databases on government computer servers; the card will simply give the code to your file and contain some basic medical information for emergency treatment like your blood type or if you have any chronic conditions that an emergency room should be aware of, like diabetes. 

UPDATED April 2008

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