The Vital Card

Today’s instalment of WordPress’ ‘365 Days of Writing Prompts is one of those worthy but dull ones, specifically about healthcare provision:

“Right to health. Is access to medical care something that government should provide or is it better left to the private sector? Are there drawbacks to your choice?”∅

Rather than enter into an earnest discussion – because if that’s what you’re looking for, then you have definitely come to the wrong place – let me tell you about one man’s struggle to obtain that crucial piece of plastic that is the ‘Carte Vitale’. The vital card indeed, the ‘Carte Vitale’ is the access key to the French national health service, which is widely held up as one of the finest in the world. It’s a ‘universal’ system, which is to say that it’s open to all.

Well, sort of…

When we relocated to France after ten years living in Abu Dhabi, in terms of eligibility for healthcare we entered a sort of limbo, because:

  • Being a mere slip of a lad of only 60 summers, I did not qualify for the automatic coverage that kicks in when you reach the official retirement age of 65. Instead I was, according to the rules (oh, those rules), not retired but rather ‘economically inactive’. Which was news to me…
  • …but wouldn’t necessarily have been a problem if the UK’s National Health Service hadn’t washed their hands of us because we had left the country, so we weren’t covered by the reciprocal agreement. I mean, it’s not as if more than thirty years of National Insurance contributions should count for anything, is it? The very idea.

We asked, of course, but the replies we got were pretty consistent and boiled down to: ‘come back when you’re 65’. So I swallowed hard and took out eye-wateringly expensive private health insurance. Hell, there are many, many other compensations from residing in France.

Although this isn’t one of them:

bureaucracy3Then, at the beginning of 2016, the French government quietly changed the rules. Now, it seemed, you only had to show proof of residence for six months to be entitled to cover – and that all-important Carte Vitale.

What could be simpler, we thought? By then we had been – officially – tax-resident in France for three years. That means that the French authorities are satisfied that we spend most of our time in France. I assume they are also quite satisfied that I pay tax on all my income (which comes from UK-based pension funds) to the French government rather than Her Majesty’s Revenue And Customs. Well, they’ve never complained.

So, with renewed hope we shipped up again at the relevant government office in Limoges. The lady couldn’t have been nicer. In fact, she was just as nice as she had been when she told us to do one back in 2013.

We got a form to fill out (natch) and a list of documents to attach in support of our application:. They were just what you’d expect – passport copy, recent utility bill, proof of income etc.

‘You can post it back to us’ she said (I translate: we managed it all in French), ‘or you can send it to our local office in Bellac’ [much closer for us than Limoges].

We weren’t falling for that one. No disrespect to La Poste, but we know quite a few people whose dossiers have ‘disappeared’, either in the mail or somewhere between Bellac and the central office. So we took our dossier back to Limoges and handed it over personally – to a real person.

‘Have we provided everything you need?’ we asked an equally nice lady. ‘Oh yes’, she said, beaming, ‘you will receive a letter with your Social Security number and then a letter asking you to send photographs so that your Carte Vitale can be issued’.

Sorted. We almost skipped down the steps and went back home.

Then we waited. And waited some more.

waiting1To be fair, we had expected this: the fonctionnaires of the French Civil Service are great believers in the concept of glacial majesty. Nonetheless, after a couple of months without hearing a thing, we were getting a little antsy.

‘They’ve lost it’, said Madame. ‘They’re on strike”, said I. We were probably both right.

Finally, I checked our postbox one day to find a thick envelope from l’Assurance Maladie. Cue scenes of tremendous excitement.

Until I opened it. ‘Your dossier is incomplete’, the letter said.

To establish that we had lived in France since January 2016, it had apparently become necessary for me to provide copies of all (yes, all) my bank statements since the beginning of 2014. Plus a different form, duly completed. And while I was at it, a sworn statement from my previous healthcare providers (the government of Abu Dhabi, as it happens) that they were no longer covering me.

There were a few other things as well, that I can’t even remember now: most, if not all of them, I had already provided. Naturally, none of them had any direct relevance to the question of whether we had actually lived in France since the beginning of the year.

‘I told you they’d lost it’, said Madame.

To cut a long story short, we did what they asked – apart from the Abu Dhabi bit, which we made up for wth a signed letter from our local mayor, stating we had lived in the commune since September 2012.

That did the trick: we’ve got ’em.

cartevitale-2Of course it made no sense. Not to a simple man such as I, who would consider it reasonable to assume that if the French tax-collection service can accept that we have lived in France for four years, then the health service pen-pushers might take it as understood that we have lived in France for the past six months.

But what do I know? It’s a free country and why should we all have to occupy the same space-time continuum?


∅ Well, the short answer to the first part is ‘yes’ (what the hell else is a government there for if not to look after its citizens?). As for the second part, it’s ‘yes’ again, because nothing is simple – or free.


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