The Healthcare System in Réunion: Organisation, GP of Record, Hospitals, Emergencies and Health Risks

Réunion comes under standard social security law: according to CLEISS (the French centre for European and international social security liaison), health insurance benefits are paid by the general social security funds (CGSS) in the overseas departments, and universal health coverage covers people who work or live in France on a stable and lawful basis, including in Réunion. The guide social security in Réunion presents the institutional framework.

The island has 62 health facilities, of which 10 public and 52 private (DREES, via IEDOM). Public hospital provision is characterised by a University Hospital located on two sites, North and South, and by two other public hospital centres: the Groupe hospitalier Est Réunion (GHER) and the Centre hospitalier Ouest Réunion (CHOR). The department has 2,920 hospital beds and places, two thirds of them in public facilities.

According to IEDOM, Réunion is converging with the national level, apart from certain specialities, but hosting capacities remain lower than in France excluding the overseas departments: 224 beds and places in medicine per 100,000 inhabitants (234 in metropolitan France) and 78 in surgery (113). These ratios are also lower than those of the other DROM (overseas departments and regions) for medicine (362 in Guadeloupe, 231 in Martinique and 277 in French Guiana). For older people, capacity is 2,354 beds or places in nursing homes and long-term care units, i.e. 48 places per 100,000 inhabitants aged 75 or over, against 134 in metropolitan France.

DREES counts nearly 3,400 doctors in Réunion, i.e. 379 per 100,000 inhabitants, a level higher than that of metropolitan France but also than that of French Guiana (261), Guadeloupe (319) and Martinique (346). The table below details the other professions. The equipment rate in facilities for disabled adults is 2.0 accommodation places per 1,000 people aged 20 to 59, against 4.2 in metropolitan France.

Access is the same as in metropolitan France: an employee opens their rights through their activity, with no minimum duration; a self-employed person from the start of their activity; a person with no occupation comes under stable and lawful residence alone and sends form S1106 to the CGSS (ameli, CLEISS). Children are dependants until 30 September of the year they turn 18 at the latest, and minors over 16 can ask to be insured in their own right (CLEISS). There is no separate local scheme, unlike certain overseas territories with a special status.

The Vitale card is presented to every healthcare professional and is updated at least once a year and after any change of situation (ameli). The detailed reimbursement arrangements, by situation and by item, are in the guide who reimburses what in Réunion.

In the coordinated care pathway, choosing and declaring a GP of record is recommended from age 16: without a declaration or without following the referral rules, reimbursement is lower. Ameli publishes for Réunion the rates applying:

• Sector 1 general practitioner or sector 2 general practitioner signed up to OPTAM (the optional price control contract): tariff of €36, i.e. €23.20 reimbursed after the €2 flat-rate contribution.
• Sector 1 specialist: €31.80 within the pathway, i.e. €20.26 reimbursed; for a one-off opinion, €72 of which €48.40 reimbursed.
• Outside the care pathway: €12.60 reimbursed for a €36 sector 1 general practitioner; the rate falls to 30% for a sector 2 doctor without OPTAM.
• Direct access: gynaecologist, ophthalmologist, psychiatrist or neuropsychiatrist (ages 16-25) and stomatologist, except major surgical procedures.
• Teleconsultation: €29.60 for a sector 1 general practitioner, of which €18.72 reimbursed.

The density of general practitioners (174 per 100,000 inhabitants) and specialists (205) exceeds that of metropolitan France (146 and 200), but access times and the split between coastal areas and the Hauts should be checked locally.

The Réunion University Hospital (CHU) is located in Saint-Denis (North site, Félix-Guyon hospital, switchboard 02 62 90 50 50) and in Saint-Pierre (South site, switchboard 02 62 35 90 00); the head office is in Saint-Paul. The CHU states that it employs more than 8,000 people in 150 occupations. The two other public hospitals are the GHER and the CHOR.

• Life-threatening emergencies: 15 (SAMU, the emergency medical service), 18 (fire brigade), 17 (police emergency), 112 (European number), 196 (sea rescue); 114 for people who are deaf or hard of hearing (Ministry of the Interior).
• On-call pharmacy: 32 37 (Réunion CHU). Mental health: 3114, the national suicide prevention number, available 24 hours a day (Ministry of the Interior).
• Hospitalisation: 80% reimbursed in a public hospital or approved clinic; hospital daily charge of €23 a day (€17 in psychiatry, ameli).

The ARS of Réunion provides a free information line on mosquitoes and the diseases they transmit, 0800 110 000, Monday to Friday from 7:30 a.m. to 6 p.m.

Medicine reimbursement rates, the medical deductible and third-party payment are those of the whole of France and are detailed in the guide healthcare reimbursement in Réunion. The prices of certain medicines are set by authorisation in the overseas departments (IEDOM).

• Vaccines: compulsory and recommended vaccines are reimbursed at 65% on prescription; MMR up to age 17, Covid-19 from age 5, flu for targeted groups, HPV and school-programme meningococcal ACWY and the RSV vaccine for pregnant women are reimbursed at 100% (ameli). The yellow fever vaccine is not covered outside French Guiana.
• Pharmacist vaccinator: the procedure is reimbursed at 70% when a pharmacist administers the vaccine. The ARS of Réunion presents flu vaccination in pharmacies in its vaccination section.
• Vaccination schedule: it is national; the ARS of Réunion, the Réunion education authority and the regional unions of health professionals run campaigns inviting 11-25 year-olds and their families to check their vaccinations.
• Traveller from Réunion: for travel to an endemic area, the ARS recommends consulting your doctor or a CHU travellers’ consultation (North: 02 62 90 68 70 or 02 62 90 55 60; South: 02 62 36 96 10).

The ARS of Réunion indicates that the tiger mosquito (Aedes albopictus) is the main vector of dengue and chikungunya on the island. Symptoms are fever, joint or muscle pain, nausea, rashes, severe fatigue and eye irritation; some cases can be serious. People to watch closely are older people, pregnant women and those with chronic diseases, notably cardio-respiratory, neurological, diabetes or hypertension. If symptoms worsen, see a doctor, or call 15 in an emergency.

• Situation: IEDOM notes that a chikungunya epidemic reached an epidemic threshold, affecting more than three quarters of businesses, mainly through absenteeism. According to the ARS, the prefect brings the arbovirus ORSEC plan down to a lower level at the end of the epidemic situation. Santé publique France describes arboviruses as sporadic outside epidemic episodes.
• Protection: the ARS ranks skin repellents, insecticide-treated clothing, mosquito nets and electric diffusers among the most effective measures, and mosquito bracelets, essential oils, ultrasonic devices and vitamin B1 among the measures with no effect. Removing larval breeding sites around the home is recommended.
• Leptospirosis: the Santé publique France bulletins indicate, in the inter-season period, a low level of transmission and sporadic cases. The ARS of Réunion publishes a section devoted to this disease.
• Flu, bronchiolitis and gastroenteritis: the bulletins report, depending on the season, flu epidemics, a rise in emergency-room visits for bronchiolitis in under-ones and gastroenteritis epidemics. An annual RSV vaccination and immunisation campaign is organised.
• Mpox: the same bulletin counts 24 cases imported from Madagascar and 5 locally acquired cases, the last having been reported in early August.

More generally, IEDOM notes insufficient prevention: one death in three is considered avoidable, diabetes is twice as common as in metropolitan France and affects nearly one person in ten.

For care that cannot be provided on the spot, the Assurance Maladie distinguishes the medical transfer (travel from home to a distant care site) from the medical evacuation (medically supervised travel from one hospital to another distant hospital). According to ameli, transport is covered subject to prior approval equivalent to a medical prescription, if the state of health justifies it and under certain conditions; medical costs are covered partly or fully if the exemption conditions are met; a companion’s travel costs can be covered under conditions; daily allowances are paid according to the usual rules; one-off financial help from the health and social action fund is possible. A practical guide to health-related travel is published by the Assurance Maladie. An assistance policy usefully supplements this arrangement for travel outside France (see repatriation and assistance).