Laura is doing a lot better. She’s still covered in spots but at least the anti-itch medicine seems to be working. I’ve had a few questions about vaccinations and healthcare here for children. This post is an attempt to answer some of those questions. Please keep in mind that this is my experience–exceptions exist to just about every rule and laws change.
To begin with France has universal health care so all children are immediately covered as soon as they are born. Universal health care does not mean that health care is free. Ignoring the hefty payroll deductions that attempt (and fail) to fully fund health care here, most medical acts and prescription drugs are only covered up to a certain percentage of the government set rate. Taking Laura to our family doctor for the chicken pox cost me 26€ (government tariff for children 2-6 years old visiting a family doctor)– 70% is covered by the SECU (French Health insurance), the remaining 30% is covered by our supplementary gap health insurance. If you choose to visit a doctor who does not adhere to the official fee guidelines, the difference between his or her fee and the government price comes out of your pocket. Gap insurance known here as a “mutuelle” covers all (or some of the difference depending on your plan) between what the SECU reimburses you and what you actually must pay your doctor. We pay each month for gap insurance. Gap insurance is also necessary for eye and dental care which are very poorly reimbursed by the SECU. Laura doesn’t have any vision problems for now but her genes indicate that she might need glasses at some point. Gap insurance doesn’t seem like a big deal if you’re healthy, however, it will save our budget if any of us needs to be hospitalized or undergo more serious treatment one day.
The Protection maternelle et infantile or PMI, as it is more commonly known, is in charge of assisting pregnant women, mothers and children from birth to 6 years old. The PMI includes midwives, early childhood specialists, pediatric nurses, pediatricians and psychologists as well as social workers and representative of the other agencies as needed. Their services are free of charge. My own experience with the PMI has been extremely limited. One week after Laura’s birth, we received a letter announcing that (unless we called to cancel it) a PMI pediatric nurse would be coming to our house in another week’s time. The PMI is automatically informed of all births. I didn’t see the harm in having her come. She weighed Laura, asked us if we had any questions, and talked about childcare opportunities. I can’t say her visit taught us anything we didn’t already know from our midwife and family doctor but I appreciated another chance to weigh Laura.
We also received a letter from the SECU with a check-up schedule for Laura during her first year. Each child has 9 medical visits which are covered at 100% rate by the SECU. The normal tariff for a child under 2 visiting a general practioner is 28€. Pediatricians are rare and overbooked where we live. As a result, since we like our family doctor, we have always used him. He can always fit us in and knows Laura well. Laura has only seen a pediatrician at the hospital. Free check-ups are offered:
- during the first week** (normally done at the hospital’s maternity unit)
- during the first month
- during the 2nd, 3rd, 4th, 5th and 6th months
- during the 9th month**
- during the 12th month
The starred check-ups involve a “Medical Certificate.” When your child is born, you receive three medical questionnaires that must be completed by a doctor. To make sure that all parents take their child to these check-ups, not only are the check-ups free but if you don’t complete them, you lose your child support money. Any other doctor’s visits are covered at 70% of the SECU fee. Laura managed to get whooping-cough in spite of being vaccinated against it so we visited the doctor a lot during her first year.
During her second year, Laura had three more fully paid doctor’s visits:
- during the 16th month
- during the 20th month
- during the 24th month**
These check-ups are useful and help to fit in a few more vaccinations without paying to see the doctor. We’ve never had to show Laura’s vaccinations to anyone other than our family doctor and medical personal, however, when Laura started her play group and then later school, we had to sign a form saying that everything was up to date.
Once your child is three, they have two fully funded check-ups per year until they turn six. In addition, the PMI also carries out medical exams in all French schools (both public and private). Most French children start la Maternelle/pre-school when they turn 3 years old. Shortly before Christmas break, Laura had to take her “medical book” to school for her 4-year check-up. (At the time she was only three but due to her January birthday, she was added to the group.) Prior to the visit, we got to complete a questionnaire about Laura’s environment and habits. Some of the questions made sense (What time does your child go to bed? Who takes care of your child outside of school hours? etc) but others had me shocked–Does you child have a television in their room? Remember this was a questionnaire for parents of 4-year old kids! A PMI nurse weighed and measured Laura before testing her vision and hearing. Since we take Laura to see our family doctor regularly, there were no surprises here. She also checked to make sure Laura’s vaccinations were up-to-date. An entire section of the check-up also dealt with vocabulary and phonetics in order to make sure her language development was on track. Children with language issues are offered additional tutoring and/or speech therapy to immediately try to correct any problems that might hurt them as they start school. (I’m happy to say Laura’s doing fine.)
I think the school visits in particular show that France is very pro-active in making sure all children receive decent medical care. Obviously some children do fall through the cracks, the occasional scandal proves that, but I do think the system is designed to look after small children. Sure it would be great if they could add the chicken pox vaccine to the vaccination calendar but at this point, it’s too late to complain! LOL