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HEALTH

Reader question: Do you have to pay if you call an ambulance in France?

In a medical emergency, the expense of calling an ambulance to transport you or a loved one to hospital should be the least of your concerns. Here’s what you need to know about the financials of falling ill in France.

Reader question: Do you have to pay if you call an ambulance in France?
An ambulance arrives at a hospital's emergency department. (Photo by SEBASTIEN BOZON / AFP)

In France, urgent emergency care is run centrally by the Service d’Aide Médicale Urgente, known to almost everyone as Le SAMU (pronounced sam-oo), which is a coordinated service to call in case of any serious medical emergency.  

Samu

You can call SAMU by dialling 15 – you should only do so in serious medical emergencies, such as loss of consciousness or chest pains.

Some operators speak English but if you’re worried about speaking French you can call the central European emergency number on 112. Although it’s not guaranteed, most of their operators speak English.  

Importantly, you should not worry about being sent away for financial reasons if you need emergency medical care – under French law, hospitals and emergency services must treat any patient in an emergency. 

You may, however, receive a bill later.

Calls to SAMU are free but you will be billed for their services, with prices for consultations and call-outs varying greatly according to the département you are in. 

If you are resident in France and either have, or have applied for, a carte vitale, the costs will be covered by state system and your complimentary health insurance (mutuelle), if you have one – in the same way as other medical costs (eg GP visit, prescription).

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

Be aware, however, that, in France, a doctor must confirm you are really in need of an emergency ambulance service, otherwise the cost of the ambulance might not be reimbursed.

In urgent situations, prescriptions for transport costs can be written afterwards. 

If you’re visiting France you will receive the bill the same bill for the cost of the ambulance, and will then have to claim back the cost from either your EHIC or GHIC card (for EU or UK residents) or via your own health insurance or travel insurance.

Sapeurs Pompiers (fire brigade)

This takes some getting used to for new arrivals, but, in France the sapeurs pompiers (fire brigade) can also be called out (dial 18) to medical emergencies, including traffic accidents and accidents in the home.

They receive extensive medical training and are more than simply ‘first-aiders’, but if the situation is very serious the pompiers may request help from the SAMU or the SMUR – these last are highly-trained medics whose role is to provide urgent care on the ground if the patient is in a life-threatening condition.

It is free to call the French fire brigade from any number, including for visitors and tourists. But unlike SAMU, you will not be billed for their services – unless, that is, you abuse the system.  

READ ALSO What to do if you have a medical emergency in France

Firefighters will bill anyone who makes a false call anywhere between €200 and €1,000 – and there’s no option to claim this cost back from anywhere.

In hospital

If your condition is serious, either the SAMU or the pompiers may take you to the nearest hospital for treatment.

In 2022, France introduced a new flat fee of €18 for treatment at hospital emergency departments known as the forfait patient urgences (FPU). This applies whether you are taken to the emergency department by emergency services or whether you get yourself to the hospital.

It applies to most people – there are exceptions – who receives treatment at an emergency room in a French hospital who does not then need to be admitted to hospital. 

Everyone is liable, whether they are French or not, whether they’re residents or tourists.

Anyone resident in France who has a mutuelle should be covered for this fee, but it is not reimbursable via the carte vitale.

READ ALSO What you need to know about France’s fees for emergency medical treatment

If your condition is serious enough that you are admitted to the hospital for further treatment, the bill depends on what treatment you receive and how long you stay.

Transport

What if you just need transporting to hospital for non-emergency appointments? Some patients are entitled to have the cost of transport covered by social security, including public transport, taxis, or ambulance – but in this case you would need to be living in France and registered in the French system.

Each area also has its own ambulance service – in most places these are white vehicles with a blue star and the name of the local authority that they are controlled by.

You may also be able to claim back fuel costs if you use your own vehicle.

The first step, in this instance, is to get your GP to fill out a prescription converting transport costs. This should also state what means of transport you should use.

You can be reimbursed for:

  • Trips to and from hospital out-patient care;
  • Care for a recognised long-term condition if you cannot get to the appointment by yourself;
  • If you have a serious condition where you need to be under surveillance or lying down during the journey;
  • Care linked to a work accident or work-related illness.

You will need approval from your local CPAM if your medical needs require the following:

  • Long-distance transport (more than 150km each way);
  • For treatment which requires at least four trips of more than 50km each way, in a two-month period;
  • If treatment requires you to travel a flight or boat trip.

Retain all receipts to send them, with a copy of the prescription authorising transportation to your local CPAM office for reimbursement of up to 55 percent of the total cost. 

READ ALSO Prescription fees and sick notes: What’s in France’s 2024 budget

Be aware that taxis you use must be ‘conventionné’ – ie licensed to transport patients. They will have a blue ‘C’ sticker in the back window.

Full reimbursement

The full cost of transportation is covered for the following: 

  • Pregnant women (six months or more);
  • Newborns less than 30 days old;
  • People who have suffered a work accident or occupational disease;
  • People suffering from a long-term illness (Affection longue durée or ALD);
  • Children and adolescents in centres d’action médico-sociale précoce (CAMSP) and centres médico-psycho-pédagogiques (CMPP);
  • Anyone entitled to complementary health insurance (Complémentaire santé solidaire or CSS) or state medical aid (Aide médicale de l’État or AME).

READ ALSO Explained: Who has to pay France’s annual healthcare charge

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COST OF LIVING

What is considered a good salary in Paris?

The higher-paying jobs are heavily concentrated in the French capital, but set against that is the high cost of living - especially the cost of renting or buying a home. So what is considered a 'high-earner' in Paris?

What is considered a good salary in Paris?

Centrist Renaissance candidate Sylvain Maillard, running for re-election in France’s snap parliamentary elections, was trying to highlight the high cost of living in the capital in a debate on RMC Radio 

“You have extremely expensive rents [in Paris], between €1,500 and €1,700, and then there are all the charges and taxes to pay,” he said.

But what most people seized on was his comment that anyone earning €4,000 a month after tax would not be considered rich in Paris – he predictably was accused of being out of touch with French people’s lives.

There’s no doubt that €4,000 a month is good salary that most people would be happy with – but how much do you need to earn to be considered ‘rich’ in Paris?

National averages

Earlier this year, the independent Observatoire des Inégalités calculated poverty and wealth levels in France.

READ ALSO How much money do you need to be considered rich in France?

According to its calculations, to be considered ‘rich’ in France, a single person with no dependants needs to earn more than €3,860 per month, after taxes and social charges. Around eight percent of single workers have this sum deposited into their bank balance every month, it said.

A total of 23 percent of workers take home €3,000 or more every month, while the top 10 percent clear €4,170. 

To be in the top one percent of earners in France in 2024, one person must bring in at least €10,000 per month. After taxes and social charges.

The median income – the median is the ‘middle value’ of a range of totals – of tax households in mainland France is €1,923 per month after taxes and social charges, according to INSEE 2021 data, which means that a ‘rich’ person earns about twice as much as a person on the median income, according to the Observatoire.

Paris situation

About 75 percent of people living in Paris earn less than €4,458 per month, according to Insee data – so according to those calculations, 25 percent of Parisians earn the equivalent of the top 10 percent in France. 

But that city-wide average still hides a wide degree of variation. In the sixth arrondissement, the median income is €4,358 per month, after tax. In the seventh, it’s €4,255.  Further out, those bringing home €4,600 a month in the 19th and 20th arrondissements are among the top 10 percent in wealth terms.

But still, the median income in Paris is €2,639, significantly higher than the €1,923 France-wide median.

That would mean – using the Observatoire des Inégalités’ starting point for wealth – that a Paris resident, living on their own, would have to bring home €5,278 per month to be considered ‘rich’. 

France is a heavily centralised country, with many of the highest-paying industries concentrated within the capital, meaning there is much more opportunity to secure a high-wage job if you live in Paris.

Cost of living

Even these figures should all be taken with a pinch of salt because of the relatively high cost of living in the capital, compared to elsewhere in France. Paris is objectively an expensive place to call home.

In 2023, France Stratégie published a report on the disposable income of French households, after housing, food and transport costs were deducted. It found that, on average, people living in the Paris region had more left to spend, due to higher incomes and despite the fact that housing costs more.

It’s the income paradox in action. A person with a take-home salary of €4,000 per month has more money to spend if they live and work outside Paris. But they’re much more likely to earn that much if they live and work in Paris, where it’s not as valuable. 

Someone who earns a ‘rich-level’ salary in Paris might not appear rich – because they live in an expensive area, and a surrounded by very wealthy people in property that’s out of reach all-but the fattest of wallets. But they’re still earning more than twice the median income in France.

And that’s what Sylvain Maillard was getting at, clumsily as he may have expressed it.

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