The Healthcare System in Saint-Barthélemy: Local Hospital, Emergencies, Health Insurance and Medical Evacuations

Saint-Barthélemy is an overseas collectivity, but remains attached to Guadeloupe for public health matters: the Guadeloupe, Saint-Martin and Saint-Barthélemy Health Agency covers the three territories, with a territorial office in Saint-Martin for the two northern islands. Its action relies on the 2023-2028 regional health project, which includes a regional health plan and a programme for access to prevention and care for the most disadvantaged, as well as on a strategic guidance framework covering 2018 to 2028.

The island has a local hospital centre, a dispensary and a care home for dependent older people (IEDOM, the overseas issuing institute). The private-practice sector complements the offer: the Health Agency counts eight GPs, fourteen private-practice registered nurses, nine surgeons and twenty-three physiotherapists. Specialities requiring a full technical platform are not available on site, because of the small population and the difficulty of keeping medical teams stable; the cost of housing also holds back the settling of health staff.

The system therefore rests on three tiers: local care on the island, outreach specialist consultations from Saint-Martin or Guadeloupe, and referral to the hospitals of these two territories for complex care. It is integrated into the Northern islands hospital group, which gives it access to the support of the Saint-Martin hospital centre thanks to a shared management.

The Caisse de prévoyance sociale (CPS) is the island’s compulsory health insurance body. It protects all working people (employees, self-employed workers and micro-entrepreneurs) as well as non-working people by virtue of residence, a criterion it checks regularly. With universal health protection, every adult is insured in their own right, subject to meeting the conditions of entitlement; the notion is presented in the glossary on the page on PUMa. The right to have healthcare costs covered opens to anyone who works or lives in France in a stable and regular way (CLEISS, the French centre for international social security links, which expressly cites Saint-Barthélemy and Saint-Martin).

For a French citizen arriving from mainland France, affiliation takes the form of a transfer. With an existing social security number, the CPS asks for form Cerfa 750, bank details, an identity document, proof of residence on the island, a front-and-back copy of the carte Vitale and, for a working person, the employment contract. Without a number, it uses form Cerfa 15763*02 for opening entitlements, with a passport or identity card for French citizens and nationals of the European Union, the European Economic Area and Switzerland, or a residence permit for other nationalities. A person born abroad adds the birth certificate with apostille and translation.

Reimbursement follows the same principles as in mainland France: the CPS reimburses part or all of the care on the basis of the rates in force, with the ticket modérateur (co-payment) and extra fees remaining payable by the insured person or their supplementary health insurer. The carte Vitale allows reimbursement within five days, and third-party payment spares you from advancing costs when the CPS pays the professional or facility directly. The employer must offer employees a supplementary health policy and help fund it. The details by situation are in the guide to healthcare reimbursement in Saint-Barthélemy.

The coordinated care pathway relies on declaring a referring doctor, who directs you to specialists; the declaration can be made online by the health professional. The hospital’s medical unit offers prenatal and postnatal gynaecology consultations, mother-and-child health consultations for infants and a vaccination service for children aged 0 to 6.

To make up for the absence of certain specialists, outreach consultations are organised in several disciplines: cardiology, oncology, psychiatry, visceral surgery, orthopaedic surgery, obstetrics, ophthalmology and ENT, thanks to doctors and surgeons visiting from Saint-Martin or the Guadeloupe university hospital (IEDOM). The Maison de la Santé, opened on 26 October 2023, offers five consultation rooms over 160 m² to strengthen this offer; in April 2024, a foundation donated an ultrasound scanner and cardiology equipment worth €100,000.

For older people, the Louis-Vialenc care home for dependent older people (EHPAD) has 30 beds and a home nursing service has been in place since 1 May 2025 for people over 60, on medical prescription. These facilities concern retirees directly; the page on retiring in Saint-Barthélemy places them in the course of life on the island.

The Irénée de Bruyn hospital centre has an emergency reception service open round the clock and a mobile emergency and resuscitation unit. It has 17 beds, 10 of them in medicine and 7 in follow-up and rehabilitation care. Radiology and a CT scanner are accessible in partnership with a health cooperation group. The facility has no operating theatre.

• Life-threatening emergency: call 15 (SAMU, the emergency medical service); 18 for the fire service, 17 for police rescue, 112 for the European emergency number and 196 for sea rescue (Ministry of the Interior).
• Maternity: the island has no obstetric unit; pregnant women are strongly recommended to move to Saint-Martin from the 37th week of pregnancy to be looked after by the Saint-Martin maternity team and give birth safely there. The CPS also cites the Pointe-à-Pitre university hospital among the reference maternity units.
• Access to the site: a feasibility study commissioned by the collectivity from the Assistance publique – Hôpitaux de Paris in May 2024 compared renovating the Gustavia hospital with a new facility in Saint-Jean, because of difficult access, traffic jams, complicated and costly evacuations, the absence of a maternity unit and dilapidated premises.

When a patient’s condition requires it, the hospital organises a medical evacuation by private aircraft: about 200 a year. They are directed to Saint-Martin for a simple condition (70 to 80% of cases) and directly to Guadeloupe in the most complex situations. Since 2023, these evacuations can be carried out at night, which strengthens the capacity to provide care (IEDOM). Passengers evacuated for medical reasons do not owe the local €5 boarding tax.

For a scheduled medical trip, coverage of transport is not automatic. Before departure, the doctor draws up a transport prior agreement request that counts as a medical prescription. Parts 1 and 2 are filed with the CPS about fifteen days before the transport, except in an emergency, for decision by the medical adviser; part 3 is kept and returned with the paid invoice, the boarding passes and proof of the appointment. Without a complete file, no reimbursement is possible.

The Assurance Maladie (French public health insurance) presents medical trips from Saint-Barthélemy and Saint-Martin in a page shared with the overseas territories: transport is covered on prior agreement counting as a medical prescription if the state of health justifies it, a companion’s transport costs can be covered under conditions, and daily allowances are paid under the usual conditions. No emergency evacuation tariff is published in the sources consulted. Assistance that covers repatriation complements the compulsory scheme: see the page on repatriation and assistance.

The basic rates of the general scheme published by the Assurance Maladie (ameli) give an order of magnitude: 70% for a GP consultation, 60% for dentists and medical auxiliaries, 80% for hospitalisation, 65% for medicines with major or important medical benefit, 30% for moderate medical benefit and 15% for low medical benefit. The CPS says it applies “the rates in force” without detailing them in its booklet.

The flat-rate contribution and medical deductibles are deducted automatically from reimbursements and capped at €50 a year per person. Exempt are those under 18, pregnant women from the first day of the sixth month of pregnancy until the twelfth day after childbirth, and recipients of the solidarity supplementary health scheme. The hospital charge, a contribution to accommodation costs after 24 hours of hospitalisation, remains payable by the patient; its amount is not given in the CPS documents. The carte Vitale is updated at pharmacy terminals.

Santé publique France (the French public health agency) tracks dengue in Saint-Martin and Saint-Barthélemy in its regional Antilles bulletin. On neighbouring territories in the region, France Diplomatie (the French foreign ministry’s travel advice) reminds readers that dengue prevention rests mainly on protection against mosquito bites and that there is no curative treatment; local instructions are issued by the Health Agency.

Hurricane Irma in 2017 was a reminder that the hurricane season, from July to October, exposes the island to water, electricity and transport interruptions: it is prudent to keep, every year before the rainy season, a reserve of treatment and the prescriptions you need. The vaccination service for children aged 0 to 6 operates at the hospital; for adults, the referring doctor reviews up-to-date vaccinations.