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.

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