Foreigners leave Paris hospitals with huge bill

Foreigners will be forced to pay upfront for treatment in Paris hospitals to try and cut down on the €120 million of unpaid health bills, many of which have been clocked up by residents of the US.

Foreigners leave Paris hospitals with huge bill
Foreigners receiving treatment at Paris hospitals will have to pay up front in future. Photo: AFP

The health authority that runs hospitals in Paris revealed on Thursday the amount of debt accumulated by foreign nationals or insurance companies who have not paid their bills for treatment.

According to a report presented by the Assistance Publique – Hopitaux de Paris (AP HP), foreign nationals as well as French people living abroad or probably more to the point their insurance companies, owed a total of €118.6 million as of November 2014. 

AP- HP now intends to put in place a process so the authority can recover what is owed when it treats foreign nationals and has decided to force those seeking health treatment in France to pay upfront.

The country that owes the most is Algeria, whose citizens have racked up a bill of €31.6 million that is yet to be paid, followed by Morocco, which owes €11 million.

Then comes the United States which owes €5.7 million, due to treatment which has either been given to US visitors or French nationals resident in the US.

Next in line comes Belgium (€4.9 million), Tunisia (€4.7 million) and Italy (€4.1 million).

The report revealed that between 2010 and 2014 the number of hospital stays by patients resident abroad rose by almost 10 percent.

The amount does not include the cost of treating foreign nationals resident in France, who will normally be covered by a combination of social security and private insurers.

Since 2013, the AP-HP has applied a 30 percent mark-up on its rates for patients living abroad (excluding emergencies or where there is reciprocal agreements in place with other countries).

That mark-up was worth around €10 million to the AP-HP in 2014.

Treating foreign patients can be a money earner for Paris’s 38 public hospitals which are under pressure to make €150 million worth of cuts.

The authority wants to boost its service to foreign nationals but at the same time stem the rise on the number of unpaid bills.

So from September onwards foreign patients or companies will have to pay in advance for any treatment given at state hospitals in Paris.

The amount will be calculated on the cost of a day plus the 30 percent mark-up.  

If no payment is received the hospitals will refuse to accept the patients.

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Fresh crisis at French hospitals as staff threaten to quit admin duties

Protests over working conditions at French hospitals have intensified after 1,200 medical staff threatened to quit their administrative duties in an attempt to force the government back to the negotiating table.

Fresh crisis at French hospitals as staff threaten to quit admin duties

In letter addressed to the French Health Minister, 1,200 of French hospital practitioners, heads of departments and managers have said they would quit their administrative duties starting January 14th – unless the government to come up with a plan to fix the ever-deteriorating state of the country’s hospitals.

“We can't do this anymore,” said Jean-Luc Jouve, Head of Pediatric Orthopedics at the hospital Timone in Marseille to the French newspaper Libération.

“Resigning from our administrative duties is a symbolic move, but it could push the situation forward,” he said.

The move –  which French newspaper Libération calls a “historic bras-de-fer” (strong-arming) – will not affect patient care, according to the staffers.

But the act impact the country's hospital services, with those joining the walk-out refusing to participate in all activities that are part of their administrative positions. 

A letter of support of those resigning has been signed by 4,894 nurses.

“We support the demand for a health service Grenelle,” the letter stated, referring to the government-led initiative last year to gather grass-roots organisations and those affected in a bid to solve the country's problem with violence against women. 

“The doctors aren't asking for anything for themselves. They continue to treat patients. The population must answer their call,” the letter said.

Non-medical staff in emergency wards across the country have been staging industrial action since March to protest at the worsening conditions for both staff and patients.

By mid-November some 268 hospital emergency wards were classed as being on strike, leading to urgent operations being cancelled in hospitals across France.

Staff from doctors to carers, gynaecologists to nurses and students, all joined the walk-out in what was described as a “historic” day of action.

“The pressure-cooker is about to explode,” was how one French news website described the situation at hospitals around France last year. 

EXPLAINED: Why French hospital emergency rooms are in crisis

So what's gone wrong?

“Public hospitals are collapsing,” read a joint statement published in November in Le Monde newspaper by 70 public health chiefs from Paris hospitals who feared the crisis was reaching an “irreversible breaking point”.

“For decades, the French public hospital system has acquired a reputation for excellence and international renown, ensuring the most modern care for children and adults, that is accessible to all, as well as research and training missions,” said the statement.

“We alert you because this system is collapsing and we are no longer able to carry out our jobs in good conditions and to provide quality and safe care.”

The problems they listed were many and varied, but also very familiar: Budget cuts, slashing the number of available beds, closures of operating rooms, staff positions that remain unfilled, overworked nurses and doctors and carers suffering from exhaustion.

The result, they say, is that access to care is reduced as is the quality of treatment patients receive. 

“Access to diagnostic, medical and surgical care at public hospitals is now extremely difficult, and those in charge of treatment and care are demotivated,” they said adding that waiting times for urgent treatment were lengthening.

READ ALSO: Just how healthy is France's health system?

Emergency services workers hold banners reading “Hell at the hospital” and placards during a demonstration in Paris on September 11, 2019. Photo: AFP.

There were similar alarm calls raised by other health officials the same week.

Yasmina Kettal, the head of the newly fromed organisation Inter-Urgences that coordinates the protests by emergency ward staff, told Libération newspaper: “It's no longer possible, we are at breaking point.”

In Le Parisien newspaper 200 staff who work in paediatric units said in an open letter: “The crisis in public hospitals exposes children to the likelihood of worsening care to the point their lives are endangered by the lack of means”.

They described how their jobs had become more like a “war doctors”, having to decide which children they could treat, how surgery had to be delayed to deal with emergencies and how some toddlers were driven 200 km to receive the right care.

Staff at emergency wards who have been part of the growing industrial action since March have a list of demands they want met.

The map below produced by the group Inter-Urgences siows the number of hospitals hit by industrial action.

Essentially they want more staff  – 10,000 more in fact – and more resources, as well as a re-evaluation of their salaries and a €300 monthly bonus in recognition of the tough conditions they face at work. 

They say their working conditions are putting them under severe strain and are putting patients in danger. They also demand the beds and wards that have been closed in recent years be reopened.
In an attempt to calm the anger of hospital staff, Agnès Buzyn had previously promised €70 million of aid, including €55 million dedicated to the payment of a monthly risk premium of €100 for staff, but unions say they have seen none of this and it's not enough.
In November French government spokesman Sibeth Ndiaye told members of  Anglo American Press Association including The Local, that while she had sympathy for the striking medics, she believed this was not the way to go about raising questions about the French health service.
She said: “President Macron does not want to make small changes and put small amounts of extra money into the system, but instead we need systemic reform.
“The system is not set up to deal with chronic conditions such as diabetes and an ageing population. We have an ageing population and more long term illnesses so we need systemic reform to provide more medical services in the community and less hospital care.
She acknowledged that there were medical professionals who were working in conditions that are “not good”.
But it may not be enough to quell the revolt, let alone restore the falling reputation of France's health service.