The Healthcare System in Saint-Martin (French Side): Hospital, Emergencies, Health Insurance and Medical Evacuations

Saint-Martin and Saint-Barthélemy have been overseas collectivities since 2007 but remain attached to Guadeloupe for public health matters. The Guadeloupe, Saint-Martin and Saint-Barthélemy Health Agency, headquartered in Gourbeyre, has a territorial office in Saint-Martin. Its missions cover prevention, health monitoring and safety, regulation of care provision in the community, in hospital and in the medico-social sector, and support for disabled people and people losing autonomy.

The 2023-2028 regional health project includes a regional health plan and a programme for access to prevention and care for the most disadvantaged, tied to a strategic guidance framework from 2018 to 2028. A local health contract, concluded between the collectivity, the Agency and the CGSS, aims to reduce social and territorial health inequalities, strengthen prevention, improve the territory’s attractiveness and retain health professionals (IEDOM, the overseas issuing institute).

The Agency counts on the island 23 GPs, 67 private-practice registered nurses, 20 surgeons and 34 physiotherapists. The French part of the island has a general hospital centre and a care home for dependent older people.

Title V of book VII of the social security code makes the general social security legislation applicable in Saint-Martin (Article L751-1); the Guadeloupe CGSS and family allowance fund are competent, each in its field (Article L752-1). The CLEISS (the French centre for international social security links) specifies that the right to have healthcare costs covered opens to anyone who works or lives in France in a stable and regular way, including in Saint-Barthélemy and Saint-Martin; the notion is presented in the glossary on the page on PUMa.

According to the Assurance Maladie, employees do not have to show a minimum length of activity, self-employed workers are covered from the start of their activity and people with no activity are covered solely by virtue of their stable and regular residence, with proof of 6 months of residence in France over the last 12 months in case of a check. A person with no activity sends form Cerfa S1106 to the fund of their place of residence. Minors remain dependants; adults are insured in their own right from the age of majority, or from 16 on request.

The details of reimbursement by situation are in the guide to healthcare reimbursement in Saint-Martin.

The Louis-Constant Fleming hospital centre is the first-aid hospital of the French part. It has an emergency reception service open round the clock and a mobile emergency and resuscitation unit. It has 92 beds broken down as follows: 17 surgery beds and 6 day-surgery places, 14 maternity beds, 16 medicine beds and 8 day-hospital beds, 6 paediatric beds, 6 neonatal beds (including 2 intensive care cots), plus 12 psychiatry beds and 2 medico-psychological centres, one for adults and one for children. The maternity unit is labelled level 2b to take account of isolation and remoteness.

• 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).
• Cancer care: since 22 November 2021, a centralised cytotoxic preparation unit allows patients in the Northern islands to receive chemotherapy on site, whereas they previously had to go to Guadeloupe, which led to people giving up care.
• Missing specialities: urology, paediatric cardiology, paediatric surgery and neurosurgery are not available locally; the hospital hosts specialists from Guadeloupe for outreach consultations by agreement, who decide whether to continue treatment on site or admit to hospital in Guadeloupe.
• Projects: a restructuring is to raise capacity from 92 to 106 beds and places, create critical care beds to avoid some evacuations and bring together the imaging and medical biology platform in partnership with private-practice professionals.

For older people, the EHPAD offers 28 places available out of an initial capacity of 40 since the damage caused by Irma; a home nursing service takes in people aged 60 and over with entitlements open in a health insurance fund, as well as, subject to the medical adviser’s agreement, younger people with disabilities or disabling illnesses. A specialised reception home opened in Concordia on 1 September 2023 and a nursing training institute is to take in a first intake (IEDOM).

When necessary, medical evacuations are organised by private aircraft from Saint-Martin to Guadeloupe. The hospital centre spends €2.5 million a year on them according to the Agency’s regional health plan, as cited by the IEDOM. Saint-Martin is among the territories for which the Assurance Maladie describes medical trips: transport is covered on prior agreement counting as a medical prescription from the health professional treating the patient, if their state of health justifies it and under certain conditions; a companion’s transport costs can be covered under conditions, and daily allowances are paid under the usual conditions in case of sick leave.

Medical costs are reimbursed in part or in full if the exemption conditions are met. One-off health and social action aid can complement cover. 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.

Medical relations between the French part and the Dutch part are limited, according to the IEDOM. Patients from Sint Maarten can nonetheless be treated in Saint-Martin, on payment for care or if their health cover is recognised by the hospital centre. In the other direction, a French insured person who is treated on the Dutch side is abroad: France Diplomatie (the French foreign ministry’s travel advice) specifies that the European health insurance card does not cover the Dutch overseas territories, including Sint Maarten, and recommends cover for medical costs, hospitalisation and medical repatriation.

The Assurance Maladie then only reimburses, possibly, urgent and unforeseen medical care, after advancing the costs and an application with form S3125, on the basis of French flat-rate tariffs; the medical adviser assesses the urgency and no appeal is possible in case of refusal. The page on living in Saint-Martin recalls the differences between the two parts of the island.

The basic rates of the general scheme published by the Assurance Maladie give an order of magnitude: 70% for a GP consultation, 60% for dentists, medical auxiliaries and optical, 80% for hospitalisation, 65% for medicines with major or important medical benefit, 30% for moderate medical benefit and 15% for low medical benefit. A €2 flat-rate contribution remains payable by the insured person for a GP consultation and a €1 medical deductible applies, for example, to a box of medicines or a physiotherapy session.

Santé publique France (the French public health agency) tracks dengue in Saint-Martin and Saint-Barthélemy in its regional Antilles bulletin. On the neighbouring island, France Diplomatie reminds readers that dengue prevention rests mainly on protection against mosquito bites and that there is no curative treatment; it also mentions vaccination and mosquito protection for chikungunya. Local instructions are issued by the Health Agency.

The hurricane season, which falls within the rainy season from July to October, can disrupt supplies and transport: Hurricane Irma in 2017 hit the island hard, and both the hospital and the EHPAD suffered damage (IEDOM). It is prudent to renew your prescriptions before this period.