The Healthcare System of New Caledonia: Local Scheme, Public Hospitals, Emergencies and Medical Evacuation

The health and social affairs department (DASS) states that New Caledonia is competent in social protection under Article 22 of Organic Law no. 99-209 of 19 March 1999 and that it has a system separate from the mainland one. It rests on two pillars. Social security entrusts the management of the compulsory schemes to bodies with the status of mutual aid societies, under the territory’s supervision: the CAFAT for employees and similar workers since 1958, and for civil servants and self-employed workers since 2002. Social assistance includes medical assistance for people who cannot benefit from compulsory insurance and have low incomes (managed by the provinces for their residents), solidarity family benefits, the Fonds social de l’habitat’s housing aid and the disability and dependency scheme created in 2009.

Supplementary health insurance comes from mutual insurers and insurance companies, and is chosen freely. The guide to social protection and health in New Caledonia presents the institutional framework, and the glossary defines the ticket modérateur (co-payment).

The CAFAT presents the RUAMM as “the health insurance of all New Caledonians”. It reimburses medical-surgical care (hospitalisation, medical and dental care, pharmacy, laboratory and radiology tests), long-term illness, maternity, invalidity and death, and can also reimburse care received outside the territory. Entitlements depend on each person’s situation.

• Employees: the employer declares the hiring. Entitlements are opened for 1, 3 or 6 months (or for a year under annualised entitlements) depending on the hours worked or the salary shown; the first month of activity opens no reimbursement, except for apprentices, vocational training trainees and civic service volunteers.
• Civil servants: no waiting period.
• Self-employed workers: compulsory affiliation, with no waiting period if contributions are up to date; under partial integration, only care covered at 100% is reimbursed.
• Pupils and students under 28 who study in the territory: dedicated insurance, with a basic contribution calculated on 50 times the hourly SMG (of the order of CFP 49,000 for a study year).
• Residents without a compulsory scheme: voluntary health insurance, open from age 16 to anyone who lives in the territory and falls under no compulsory scheme; the contribution is 4.67% of the RUAMM contribution ceiling (amount revised each year), or half if income is less than or equal to 18 times the SMG of the previous December.

Dependants are the spouse, the PACS partner (civil partner), the cohabiting partner (established cohabitation for at least 12 months), dependent children and grandchildren (up to 18 with no condition, up to 21 if they continue their studies) and, subject to income conditions, the insured person’s parents, provided they have no compulsory cover of their own. Entitlements take effect on the date the complete file is received.

A French citizen who settles does not need to ask for authorisation to access care, but must be affiliated to the scheme that matches their situation. The CAFAT specifies that a former employee from mainland France who does not take up work on site does not keep their entitlements to mainland Sécurité sociale (French social security): they affiliate to voluntary insurance, with no waiting period, with cover from the first day of affiliation subject to the required number of hours. The page on people covered by voluntary insurance also targets insured persons of a mainland scheme who can no longer receive its benefits because they live in the territory.

The steps rely on the coordination agreement with mainland France, which rests on decree no. 2002-1371 of 19 November 2002 according to the CLEISS (the French centre for international social security links): an employee who has worked in mainland France presents form SE 988-02 and their last six payslips, a seconded worker SE 988-07 with SE 988-01, a retiree SE 988-06, and a dependant who comes alone SE 988-05. The file is filed at the CAFAT one-stop desk (4 rue du Général Mangin, in Nouméa) or by post (CAFAT, BP L5, 98849 Nouméa Cedex), and dependants are registered with the beneficiary registration file sent to maladie@cafat.nc. The details by situation are in the page on healthcare reimbursement.

The DASS lists three public hospital facilities: the Gaston-Bourret territorial hospital centre (CHT), the Albert-Bousquet specialised hospital centre (CHS) and the Northern hospital centre (CHN). The CHT is the territory’s public reference facility: it has a unique technical platform with emergency, intensive care and operating theatres, employs more than 2,000 staff and has occupied the Médipôle de Koutio, in Dumbéa-sur-Mer, since December 2016, a building certified high environmental quality and certified by the Haute Autorité de santé (the French health authority). Its medicine unit covers in particular pneumology, internal medicine, geriatrics, cardiology, neurology, oncology, palliative care, diabetology and nephrology; its surgery unit, ophthalmology, ENT, visceral surgery, orthopaedics-traumatology and day surgery; its mother-and-child unit, the maternity ward.

The CHS Albert-Bousquet is the reference facility for mental health, and the CHN provides public hospital care in the North province. Private-practice health professionals complement the hospital offer; the DASS publishes a health directory and a map of health facilities. No health expenditure as a share of GDP is put forward here, for lack of an official figure read for the territory.

Emergencies: in a life-threatening emergency, the CHT says to call 15 (SAMU, SOS Médecins). For an urgent delivery, call 20 80 00 and ask for the midwife on duty in the delivery room. The CHT has emergency departments; opening hours and the exact address are given on its access plan.

Medical evacuation (EVASAN): it concerns care that cannot be provided on site. The doctor sends a request to the CAFAT, and a medical committee examines the file; the destinations cited by the CAFAT are mainland France and Sydney. For mainland France, the patient presents guarantees of payment for medical costs and accommodation, a valid passport, their ticket and their medical file. The accommodation offered by the EVASAN manager is covered; accommodation chosen elsewhere is reimbursed up to €60 a day, as are medically justified journeys on prescription. The companion of a minor or dependent patient has their accommodation, meals and transport covered on the same terms. In case of an urgent return for personal reasons, the outward and return journey remains at the patient’s expense. An assistance contract can complement this arrangement; see also the definition of medical evacuation.

Care outside the territory: in mainland France, for a short stay, the patient advances the costs and the CAFAT reimburses at CAFAT rates on the basis of Sécurité sociale tariffs; for a long stay, a professional assignment or a move, the coordination agreement allows reimbursement by mainland Sécurité sociale. Abroad, only hospitalisations of at least one night for unforeseen and urgent care are reimbursed; the CAFAT recommends travel insurance.

Pharmacy is part of the RUAMM medical-surgical benefits, at the rates set by the CAFAT in its reimbursement rates leaflet; the DASS devotes a section to medicines. As for vaccinations, the DASS states that most vaccines on the childhood schedule are compulsory (diphtheria, tetanus, poliomyelitis, tuberculosis with the BCG, and whooping cough since 1987) and that a child must present an up-to-date vaccination certificate to enter nursery, day care or school. It also recommends flu vaccination every year from age 65, for pregnant women and for people with chronic illnesses, whooping cough vaccination at each pregnancy, and Covid-19 vaccination in certain cases.

Dengue: the DASS reports the return of dengue, whose transmission is favoured by the rainy season, and states that areas not protected by the Wolbachia method carry a higher risk. It recommends seeing a doctor quickly in case of a fever of 39 to 41 °C with headaches, muscle and joint pain and tiredness; the test is covered. Only paracetamol is advised, as aspirin and anti-inflammatories such as ibuprofen can make the illness worse. Chikungunya and Zika are transmitted by the same mosquitoes, with the same prevention: emptying containers after each rain, wearing long, light-coloured clothing, and using repellents and a mosquito net. The DASS also has a Health and Travel Centre for people leaving the territory.