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Explained: Why do the French love thermal spa cures so much?

Thermal spa treatments in France are incredibly popular and can even be prescribed by doctors for conditions ranging from heart disease to digestive problems.

Published: 20 January 2022 14:19 CET
A women receives a thermal bath treatment in France.
A women receives a thermal bath treatment in France. Such procedures can reimbursed by the French state if carried out for medical reasons. (Photo by GEORGES GOBET / AFP)

How big is the thermal spa sector in France? 

326,000 people visited thermal spas for treatments in 2021 according to the head of the Conseil national des établissements thermaux (National Council of Thermal Establishments). Those who visit these places are known as curistes. 

There more than 100 stations thermales in France – establishments that provide medical care with heated mineral water and mud. 

France has more than 770 thermal springs which provide the key ingredient for such treatments.

In 2019, there were 850 doctors specialising in delivering thermal treatments in France. That same year, 0.15 percent of reimbursement payments made by the Assurance Maladie (the French public health system) went to people who had undergone thermal spa treatments 

Those representing the sector say that it employs more than 100,000 people directly and indirectly. 

How does it work? 

We’re not just talking a spa day here.

A cure thermale is different from thalassothérapie – the former is used to treat medical conditions and must be proscribed by a doctor while the latter is used simply to relax. If you go with a few friends to a spa for a day of relaxing and gossip with a massage, a sauna and perhaps a facial that is not a cure thermale. 

You can receive treatment in a cure thermale for problems linked to rheumatology (conditions like arthritis), gynaecology, phlebology (veins), neurology, cardiology, urology, dermatology, child development, digestion, metabolic issues, psychosomatic illness, respiratory problems and buccolingual health. 

Power showers form an integral part of spa therapy treatments in France

Power showers form an integral part of spa therapy treatments in France. (Photo by GEORGES GOBET / AFP)

The standard duration of a cure thermale treatment is 18 days, which are divided into periods of treatment, physical activity and rest. 

The treatment generally begins in the morning and last between 2-3 hours. Patients will undergo 4-6 treatments per day. They can be delivered individually or as part of a group depending on the prescription given by a doctor. 

The exact treatment you will receive is determined by a doctor once you arrive at a station thermale depending on your illness and overall state of health. Common features are massages, steam room sessions, mud baths and power showers. 

Is there any science to support the idea that these treatments are useful?  

Representatives of the cure thermale sector point to studies written by thermal medicine researchers which, surprise surprise, show thermal spa treatments to be effective in treating a whole range of conditions. 

But other research has also pointed towards benefits. A paper published in the British Medical Journal found that thermal spa therapy was an effective treatment for the management of knee osteoarthritis; and other peer-reviewed studies found that the mineral water used has health benefits. 

READ MORE Are the French falling out of love with spa cures?

But there are sceptics however.

“Medical benefits of thermal treatment have been observed in patients with rheumatic conditions, psoriasis, venous insufficiency, ENT conditions, gynecolgical disorders, and anxiety. Unfortunately, many publications in this area suffer from methodological flaws,” notes the French National Academy of Medicine. 

A lack of control groups and financial interests behind many of the studies into the efficiency of thermal medicine means that the jury is still out on thermal spa treatments. 

How can I get my spa treatment reimbursed? 

You can pay for treatments yourself, but depending on your state of health the government might pay some of the costs, as the French social security system has been reimbursing cure thermale treatments since 1947. 

You can get your treatment partially reimbursed by the French state if you have obtained a prescription from a doctor. You can get one stint in a thermal spa reimbursed per year, for 18 days. Reimbursement typically amounts to 65-70 percent of the cost of the treatment and is transferred into your bank account after you have paid for the treatment itself. You need a French carte vitale to benefit. 

READ MORE How to get a carte vitale in France and why you need one

Thalassothérapie – the relaxing spa day – is not reimbursed. 

Your doctor is the one who decides which thermal spa you should attend – each one is specialised in treating certain illnesses. 

Before receiving treatment, your doctor will have to sign and provide you with this form, which must then be submitted to the Assurance Maladie (French public health system). You must also fill out a déclaration de ressources, providing evidence of your salary or any other earnings. This must also be sent to the Assurance Maladie – you can find the postal address where you must send your documents in the démarches à accomplir section of this website. 

If you earn more than €14,664.38 annually, your transport costs to the treatment centre or stay at a hotel will not be reimbursed by the French state. If you earn less than this, you should submit evidence and can have 65 percent of transport (the price of a second-class SNCF ticket to the treatment centre) and hotel fees paid (up to €97.50 per day) back to you. 

How has the Covid-19 pandemic affected the sector? 

Covid-19 has hit the thermal spa sector hard. 

The National Council of Thermal Establishments says that the number of clients receiving treatment was 43.3 percent lower in 2021 than in 2019, before the pandemic began. 

Thermal spas in France have been forcibly closed for months at a time during the pandemic.

Thermal spas in France have been forcibly closed for months at a time during the pandemic. (Photo by GEORGES GOBET / AFP)

Access to thermal treatment centres is contingent on being fully vaccinated (for now, not all centres require you to have had a booster); a negative PCR test taken 72 hours before entering the centre if you are unvaccinated followed by bi-weekly tests during your treatment; or proof of recovery of Covid (a positive test between 11 days and 6 months old). Mask wearing is required in communal areas of treatment centres. 

Dozens of thermal spas in France have begun treating patients with symptoms of long Covid, such as loss of taste and smell, chronic fatigue and brain fog. These treatments are not currently reimbursed by French social security, but the sector is trying to negotiate a deal with the Health Ministry to make this happen. 

“Thermal medicine can contribute to the management of certain after-effects of Covid-19 by a support to more efficient ventilatory mechanics and motor functions and by a relief of the stress following a prolonged stay in an intensive care unit,” said the National Academy of Medicine. 

Other information 

You can read more about the process of getting thermal spa treatments reimbursed here. 

The National Council of Thermal Establishments has an interactive map where you can search for treatment centres by geographical area and speciality. 

If you are interested about the alleged benefits of thermal spa treatments, an exhibition is currently being held at the Carousel du Louvre in Paris, until January 23rd. Tickets are free but you must subscribe to the event here. 

Lyon will also hold an event bringing together thermal spa practitioners from January 28th to January 30th at the Eurexpo centre. You can get more information about that event here.  

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READER INSIGHTS

‘We moved here for the healthcare’: How foreigners view France’s social model

As France mulls cuts to some services to reduce the country’s deficit, readers reveal their experiences of health and social care here.

Published: 10 April 2024 15:37 CEST
'We moved here for the healthcare': How foreigners view France's social model

From free taxi rides for patients to state grants for holidays and concert tickets, via a robust system of benefits and healthcare, the French social model – funded by taxes – has long been renowned as a generous one.

But finance minister Bruno Le Maire has indicated that some services will need to be cut as the French deficit is high and steadily rising.

So we asked our readers – is France’s social model really too generous? Or does it serve the people who live here well, in exchange for their hefty tax contributions?

Healthcare

We started off by asking people about their experiences of French healthcare, and whether they believe any changes should be made.

Overall, people were very positive about the French health system with most saying they had had good experiences and several people expressing gratitude for French medics who had saved their lives.

Pamela, from Bayeux, wrote that French benefits and healthcare services are, “Excellent”. “I pay a lot of tax and cotistations,” she wrote, “I feel like I get a fair return on this.”

Liz Barclay, who lives in Aveyron, wrote that an American friend’s six-day hospital stay and surgery following a heart attack cost around €11,000 in France compared to around $250,000 in USA. The care the friend received was ‘highly praised’ by an American cardiologist, she wrote.

She added that, “Regular doctor visits at €25 or even €30 seem very cheap.”

In fact, the general consensus among the responses is that care and services are mostly excellent – Alphonse Thompson went so far as to say it was: “Excellent, humane and a model for the Anglophone world”.

And Eric Stillwell, from Lot, said: “We moved here for the healthcare and believe it should be the model for more countries.”

D Packman, in Paris, wrote about the “Quality services, reasonable costs” of social and healthcare services in France.

READ ALSO How to get a carte vitale in France and why you need one

American Amy Freeman said: “I have used the system three or four times. I love the ease of making appointments and the bills were very low. I have never abused the system or asked for more than I needed. Probably because I am American and am terrified of getting a massive bill. I can’t seem to shake that mentality no matter where I live.”

Social benefits

France’s social benefits are also potentially in line for cuts, especially unemployment benefits, so we asked our readers who had used those services what they thought.

A Var reader pointed out: “[U]nemployment benefits are not unreasonably generous and only available if sufficient working contributions prior to losing a job.”

Richard Romain, who lives in Aude, described the French model as, “socially inclusive and allows people to get into employment”.

He added: “My employer received a grant over five years for employing me as I am disabled. I also got 100 percent grant for adapting my place of work.”

And Andy Parsons, who has lived in Calvados since 2007, said the system was: “Easy and generous. As a full time carer for a three children, one of whom has disabilities, the allowances were generous and the tax breaks enormous.”

But not everyone agreed. Aditya Das, who moved to Lyon from India, was one of a few respondents who felt France’s social model was ‘too generous’. Das argued that “some undeserving people” benefit from a combination of state aid that keeps, “able bodied people from working”.

And A McKnight, from Argenteuil, wrote: “Every area of benefits goes too far – there need to be clear conditions and termination points set in place.”

Carol Schoen, who lives in Strasbourg, argued unemployment payments were too high: “There is too much abuse and not much incentive to get a job … [and] child allowances are too generous and don’t always benefit the children.”

And Ceinwen Reeves Izzard, from Dordogne, said that the model may be weighted against some, pointing out the, “[l]ack of generosity in sick pay for self-employed people who are too ill to work when others get spa treatments on prescriptions”.

Cuts

And finally the million euro question – is there anything that is too generous and should be cut?

While some argued that unemployment benefits are too generous and don’t incentivize work, others looked for savings amid healthcare. 

Reimbursed taxi costs for certain appointments, prescriptions for spa treatments and over-medication were causes for concern.

READ ALSO How to get free transport to medical appointments in France

Most people, however, advocated limiting or means-testing certain services, rather than axing them altogether.

“France could certainly eliminate free taxi rides to appointments for people who can drive themselves or can easily find a ride,” wrote Barclay, an view echoed by Pamela, who added: “It’s more the abuse that bothers me than the existence of the service. I see a lot of Britons living here taking the mickey with it.”

Several readers – especially those living in rural areas – told us they had used the taxi service to travel to vital medical appointments including cancer treatments. 

Several people also flagged up waste when it comes to medication, or just general over-prescribing (and it’s true that the French are among the most highly medicated nations in the world).

Robert Hodge, living in the Vendée, said: “The amount of medication issued by pharmacies needs to be limited to that which is actually prescribed. Two pills a day for six days should be 12 pills and not 20 just because they come in boxes of 10.”

Ceinwen Reeves Izzard added: “They are overly keen to prescribe MRIs, I have had multiple. They oversubscribe medication. I have lots of morphine locked in a safe because the pharmacy wouldn’t take it back.”

Matthew Davison agreed, adding: “The big one is medication. My doctor might prescribe 3 pills a day for 5 days, but the pharmacy will give me the double because that’s the amount in one box. This creates so much waste. I have a cardboard box filled with leftover medicine I didn’t need.”

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