The Healthcare System of French Polynesia: Generalised Social Protection, Hospitals, Emergencies and Medical Evacuations

The High Commission reminds readers that, owing to French Polynesia’s autonomy status, the collectivity holds full competences in health and social affairs, and therefore has its own social cover and health insurance system. There is neither a primary health insurance fund nor a general social security fund on site, but a local fund, the CPS. According to the IGAS/IGA/IGF report, the generalised social protection, in place since 1995, covers the risks of sickness, industrial accidents and occupational diseases, family, old age and, more limitedly, disability; sickness and maternity cover is identical from one scheme to another.

The report counted more than 160,000 members of the employees’ scheme, about 17,000 of the non-salaried scheme and more than 64,000 of the solidarity scheme, as well as nearly 27,000 people, mainly State civil servants and their dependants, who come under mainland Sécurité sociale. These figures are old: the CPS publishes up-to-date data. The guide to social protection and health in French Polynesia describes the institutional framework.

• General employees’ scheme (RGS): the employer declares each employee to the CPS; sickness and maternity benefits require 80 hours of paid work a month or pay at least equal to the SMIG (25 hours a month for mothers of a disabled child or of at least three children under 14), according to the CLEISS. Entitlement to benefits is maintained for 180 days after a redundancy for economic reasons, 90 days with 12 months of contributions, 30 days in other cases.
• Non-salaried scheme (RNS): compulsory affiliation for a self-employed person whose declared average gross monthly income reaches CFP 87,346 (CFP 97,346 for a household), who has lived in French Polynesia for more than 6 months and comes under no other compulsory scheme; self-employed people who do not meet the residence condition can join voluntarily.
• Solidarity scheme (RSPF): open after more than 6 months of residence to people with no other scheme whose income is below CFP 87,346 a month (single person) or CFP 97,346 (couple or with children).

For a French citizen from mainland France, the rule stems from coordination decree no. 94-1146 of 26 December 1994: the worker comes in principle under the scheme of the territory where they work. The High Commission specifies that mainland universal health protection excludes the Pacific overseas collectivities from the notion of residence in France: civil servants, military personnel, magistrates and national contract staff remain subject to mainland Sécurité sociale, while contract staff recruited locally come under the CPS. A non-working spouse is, by default, covered neither by Sécurité sociale nor by the CPS on arrival, as the CPS requires 6 months of residence for the solidarity scheme. The details by situation are in the page on healthcare reimbursement in French Polynesia.

According to the CLEISS, employees’ health insurance reimburses 70% of the CPS reference tariff, the remaining 30% being borne by the insured person. Cover is 100% for hospitalisation, sick leave of more than 30 days, pregnancy-related care, premature babies and medical evacuations, among other cases. For long-term illness, consultations related to the condition are reimbursed at 95%, prescriptions and hospitalisation at 100%, unrelated care at 70%. The High Commission adds that claim forms are sent to the CPS in the year following the care and that some services reimbursed in mainland France, such as dental care or optical, are not necessarily reimbursed in the same way on the CPS basis.

The CPS has introduced the obligation to declare a referring doctor; according to the High Commission, the Country’s government was able to suspend the increase in the ticket modérateur (co-payment) for not following the care pathway: the applicable rule should be checked with the CPS. Insured people have a CPS card and an online space (Tatou); members of mainland Sécurité sociale keep their Ameli account and carte Vitale in parallel. See the glossary entry on the ticket modérateur (co-payment).

The Centre hospitalier de la Polynésie française (CHPF), located in Taaone, in Pirae, opened at the end of 2010 and presents itself as the territory’s reference and last-resort facility; it has 490 beds, 45 of them intensive care, with in particular haematology, medical biology, nuclear medicine, a blood transfusion centre and an addiction service. The IGAS/IGA/IGF report describes it as the only facility with the full range of disciplines, with a mission close to that of a university hospital.

Four local hospitals, in Taïohae (Marquesas), Taravao, Uturoa (Raiatea) and Moorea, complete the offer; the report counted about a hundred installed beds and noted that their activity remains limited by their size and by their medical resources. For the most remote islands, medical evacuations between islands to Papeete numbered in the thousands. The Health Directorate’s facilities provide first-line care in the islands. Private facilities also exist, and a supplementary health or assistance contract helps cover their cost.

The Health Directorate recommends calling 15 in an emergency. Medical evacuation out of French Polynesia is offered when care cannot be provided on site, for lack of suitable resources. It is organised by the CPS medical control administrative department, which arranges departures to mainland France, New Zealand and between the islands for all nationals, on the advice of the medical advisers. The IGAS/IGA/IGF report put the number of evasans to mainland France and New Zealand at between 600 and 700 a year, and estimated that this spending, transport included, represented nearly 11% of the Country’s health spending.

Cover differs depending on affiliation: a CPS insured person has transport, care and accommodation covered, while a member of mainland Sécurité sociale only benefits from the advance of the return ticket (and the transfer from the airport), with accommodation, meals and travel remaining at their expense. The glossary defines medical evacuation, and the page on repatriation and assistance presents the supplementary contracts.

The Health Directorate publishes recommendations for travellers. The yellow fever vaccine is compulsory for people who stayed in the previous 15 days in a high-risk country, mainly in Latin America and Africa; flu, Covid-19 and hepatitis B vaccines are recommended. The instructions cover dengue (repellents, mosquito nets, immediate consultation in case of a sudden high fever with headaches), drinking water or bottled water, ciguatera linked to eating lagoon fish, leptospirosis (do not walk barefoot in dirty water or mud when it rains), centipede bites, stonefish stings, immediate disinfection of wounds, especially those caused by coral, and protection against heat.

Medicines follow CPS rates; some, such as homeopathy and medicines with moderate medical benefit, are reimbursed at 30% for long-term illness. For trips outside the territory, the High Commission recommends taking out travel insurance covering health, evacuation and repatriation costs.