‘Everything has stopped because of Covid’ – the social tsunami hitting Paris’ suburbs

In a gritty Paris suburb, Zineb, Danielle and even Benjamina, who is in his late 70s, say they only want one thing: to desperately get back to work.

'Everything has stopped because of Covid' - the social tsunami hitting Paris' suburbs
Poverty among young people in France is also on the rise. Here students queue to collect food boxes, fruit and some sanitary items from a help association in Paris on January 28th. Photo: AFP

Like towns all over the world, residents of Grigny, about 30 kilometres south of the French capital, are struggling after losing jobs in the pandemic.

But this downtrodden town, with its sprawling high-rise, low-cost housing estates, was already known as the poorest in mainland France.

Nearly half its 30,000 residents, many of them immigrants, live below the poverty line, surviving on less than €900 a month, according to the Observatoire des Inégalites, a non-governmental body that studies inequality in France.

Grigny mayor Philippe Rio said he fears the percentage has only increased further since the virus outbreak, given the number of people signing up for state aid.

One of them is Benjamina Rajoharison. 

Despite being aged 77, he used to do manual work which he said paid well.

But he has been out of a job for nearly a year and now he and his wife scrape by on welfare payments.

Once the monthly rent of €580 is paid, the couple is left with €300 to make ends meet until the end of the month.

“That's nothing at all,” Rajoharison told AFP.

He hopes to find odd jobs to survive once all the Covid-19 related restrictions are lifted, he said.

The couple lives on the 10th floor of a tower block in Grigny 2, one of Europe's biggest housing complexes and also one of the most run-down in France.

Piles of rubbish are strewn at the entrance of some of the buildings whose doors are shattered. 

But Rajoharison's little studio flat is neat and tidy, and decorated with pictures of flowers.

Rio, the mayor from France's Communist party, says that the pandemic has exacerbated poverty, especially in the housing estate, which he says has become a “ticking time bomb.”

“Between last March and December, the number of unpaid charges, including for water and heating, has practically doubled,” he told AFP.

“And if we can't pay for the water and heating, that means we also can't pay for upkeep and emergency repairs.”

The charity Restos du Coeur has been active across the country throughout the pandemic, here distributing food to people in need in Toulouse, southwest of France.Photo: AFP

'Social tsunami'

On a recent day, a few streets from the tower block, some 40 people waited in line for free meals and other goods distributed by the Restos du Coeur charity, which hands out food packages and hot meals to those in need.

The association has seen a significant jump in the number of people seeking assistance because of what Rio describes as the “social tsunami” brought upon by the pandemic.

Among those in the queue is Danielle, a 21-year-old from Ivory Coast in need of nappies and milk for her baby daughter.

“Before coronavirus, my partner and I worked a bit but since the first wave of the pandemic, we haven't been able to find jobs,” said Danielle, who is undocumented and previously earned money cleaning houses.

Naima, 37, who is French-Moroccan and used to work under temporary employment contracts, says she has seen her living standards dip even further.

“Everything has stopped because of Covid,” she lamented. “It has impacted my personal life and I feel depressed.

“Thankfully, we have income support” which guarantees a minimum income to those in need.

Zineb, a Moroccan in her 30s who is also undocumented, dreads losing the social interaction she currently enjoys at the Resto du Coeur, once winter is over.

“When I set foot in the Resto du Coeur, I forget my troubles and I feel strong and happy,” said the mother, who lives with her two children in a tiny, stuffy hotel room with bunk beds, a sofa bed, a small desk and kitchen utensils and plates stored in the shower.

Many people are reliant on food assistance for survival, even though the key challenge now is getting back to work and finding jobs, Rio said.

“One year after the quake caused by the first lockdown, we now  now that the crisis will be long-lasting,” he said.

France's economy shrank 8.3 percent in 2020, data released last month showed, as the virus plunged countries across Europe into their deepest recessions since World War II.

Rio was among several mayors who wrote to President Emmanuel Macron last year pleading for assistance for his town.

Since then, the government has pledged to allocate one percent of its recovery plan to suburbs like Grigny.

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Why medical costs are rising in France in 2024

Two changes set to come into effect in 2024 will leave French residents facing higher costs for prescriptions and medical appointments.

Why medical costs are rising in France in 2024

In January, the French government announced plans to double two healthcare expenses, the ‘franchise médicale’ and the ‘participation forfaitaire’.

Both of these are fees are deducted from the reimbursement of medical costs such as prescription charges and appointment fees, but they are applied in different circumstances.

How the fees work

France’s healthcare system works on a reimbursement model – you pay the doctor, pharmacist or other medical professional up front and then some or all of the cost is reimbursed to you by the French state.

But the exact amount that you are reimbursed is worked out according to a complicated formula that takes into account your personal circumstances, the type of treatment you are having and the status of the doctor who is treating you.

You can find a full explanation of how it works HERE.

However, after the reimbursement is calculated a small amount is subtracted from the total cost – the ‘franchise médicale‘ and the ‘participation forfaitaire‘. These costs (usually around €1) are therefore not reimbursed.

Generally, any costs that are not reimbursed by the state will be covered by the ‘top-up insurance’ known as a mutuelle, if you have one. However the ‘franchise médicale‘ and the ‘participation forfaitaire‘ are not covered by a mutuelle either, so you pay them out of pocket.

Franchise médicale

The ‘franchise médicale’ is applied to prescriptions, visits to ‘paramedical’ professionals (including appointments with nurses, physiotherapists and masseurs, speech therapists and eye specialists), and non-emergency medical transport.

From March 31st 2024, the franchise médicale will double – going from €0.50 to €1 for prescriptions and ‘paramedical procedures’ and from €2 to €4 for patient transport.

There is currently a cap of €50 on the total amount you can pay in franchise médicales per year. This will remain in place despite the increased charges, according to the French government site Service-Public.

There are also caps on the amount that can be charged in franchise médicale in one day, and this will increase after March 31st as well.

The maximum amount that can be charged in one day in franchise médicales for paramedical appointments will raise to €4, instead of €2 previously. Meanwhile, for medical transport, the maximum will go up to €8 in one day, instead of €4 previously.

Does everyone have to pay this?

Some groups do not have to pay franchises médicales;

  • children under the age of 18;
  • beneficiaries of complementary health insurance (Complémentaire santé solidaire) or state medical aid (Aide Médicale de l’Etat – AME)
  • pregnant women from the first day of the sixth month of pregnancy until the 12th day after giving birth;
  • minors purchasing contraception and/or the morning-after-pill without parental consent;
  • victims of terrorism

How does it work in practice?

You will continue to pay the same price for prescriptions, appointments and transport, but the reimbursement amount you receive will be slightly less.

So let’s take a prescription as an example; you pay the pharmacist €10 for a box of tablets that have a reimbursement rate of 65 percent – you will be reimbursed €5.50 (65 percent of €10 is €6.50, minus €1 franchise médicale equals €5.50). 

If you have a full-cover mutuelle, you will receive €3.50 from the mutuelle, leaving you to pay €1.

What about the participation forfaitaire?

This is the same principle as the franchise médicale, but is applied to different types of healthcare –  specifically any appointment with or procedure carried out by a general practitioner or specialist, as well as X-Rays, scans and lab tests.

Previously, it was set to a flat rate of €1 across the board. However, starting in June 2024, it will increase – the exact amount is still to be clarified, but it will not be more than €3, according to the government decree.

Like the franchise médicale, there will be a €50 annual cap on costs.

How does this work?

As with the franchise médicale, you will pay the same price for appointments and treatments, but the reimbursement will be slightly less.

Let’s take as an example an appointment with a GP who is ‘sector one’ – the standard charging rate for GPs – which are reimbursed at 70 percent.

Assuming that the new charge is €2, you would pay the standard appointment fee of €26.50 and will be reimbursed at €16.55 – 70 percent of the €26.50 (€18.55) minus €2.

If you have a mutuelle, it would cover €7.95, leaving you to pay €2. 

Why raise rates?

The French healthcare system is currently in deficit and the government is hoping that the charges will allow it to raise additional funds – although the vast majority of healthcare funding continues to come from the public purse, via taxes and social charges.

According to RTL, increasing these charges will allow the state to add take in about €800,000 million in funding.