The Green Card and the Pharmacy Where You Barely Pay — Epoche B1
The carte Vitale is a green plastic card, the size of a bank card, and it is what makes a French pharmacy so disorienting the first time you use one. You hand over the prescription, the pharmacist hands over the box, you tap the card — and most of the price simply never reaches you. Here is the whole journey of one prescription. 1. The surgery A standard consultation with a general practitioner has a set national fee, around thirty euros as of this writing. You pay it and give the card to be read. 2. Two or three days later Most of that money is back in your bank account, transferred automatically. The public scheme reimburses about seventy per cent of the official fee, minus a small fixed contribution that everyone pays on each visit. Nobody fills in a form; the card did it. 3. The pharmacy Here comes the strange part, called tiers payant — literally "third-party payer". The pharmacy bills the insurer directly, so you advance nothing for a medicine on the reimbursed list. You may pay a euro or two, or nothing at all. 4. The mutuelle The share the state does not cover is picked up by a complementary insurer, the mutuelle . Most employees have one through work. It is the second layer, and it is why "seventy per cent" rarely feels like thirty per cent missing. What strikes me, having done this a few times now, is that the system does not abolish the bill — it moves it. Someone still pays; the money is simply collected before you are ill rather than at the moment you are. That sounds like a technicality. Standing at a counter with a fever, it does not feel like one. References République française (2004). Loi n° 2004-810 du 13 août 2004 relative à l'assurance maladie. Journal officiel de la République française, 17 August 2004. Chevreul, K., Berg Brigham, K., Durand-Zaleski, I. & Hernández-Quevedo, C. (2015). France: health system review. Health Systems in Transition, 17(3), pp. 1–218.