Emergency Medical Services in France - Funding and Costs

Funding and Costs

In France, the 100 or so SAMUs (one for each Department) are all operated by public hospitals. Public hospitals (unlike private hospitals, and France has both) receive government funding. France operates on a system of universally accessible socialized medicine. Patients have freedom to choose physicians, hospitals etc., and there are prices set for each type of service.

When operating in the public system, patients are asked to co-pay a portion of the cost for each type of care that they receive. To illustrate, a patient requiring hospitalization is liable for 20 percent of costs for the first month, and nothing thereafter.

What this means in terms of funding is that the SAMUs and their SMUR response teams are funded by the government, by means of the hospital funding scheme. They do charge a fee for service, and for a typical patient, 65% of this cost will be covered by the government health insurance scheme and the balance covered by optional additional private insurance. By French law, in an emergency any French hospital or SAMU must treat any patient, regardless of their ability to pay.

As a measure against system abuse, the SAMU physician may refuse to sign the patient's 'treatment certificate,' resulting in the patient being liable for the full cost of services provided, although in practice, this is rarely done. Most French citizens also carry private health insurance in order to cover all co-payment charges.

In some circumstances, particularly on low-priority calls, patients being transported to hospital may be asked to pay for service in advance, and then seek reimbursement from the government insurance scheme or their private insurance. Although not regarded as ambulances in France, fire department ambulances, when used, provide transportation to hospital without charge. All requests for ambulance service are processed by the local SAMU, which will determine what type of assistance and transportation resources are sent; the patient has no choice in the matter when it is an Intensive Urgent Care Need.