Social protection and health in Wallis and Futuna

Wallis and Futuna has neither a health insurance fund nor a social security system covering the health risk. The Senate states this in its report on the draft finance bill: care is funded by the State and delivered free of charge in its establishments, on the basis of Article 68 of the 1972 Finance Act, under which the hygiene and public health service falls to the State. The Agence de santé, created in 2000, is a national public establishment of an administrative nature, placed outside the scope of health insurance, and it depends almost entirely on the annual State allocation (an operating budget of about €50 million a year). The principle of free care for residents was reaffirmed by the crisis-resolution protocol of 19 September 2024 ("care remains free for residents of Wallis and Futuna"), as reported by the inspectorate general of social affairs.

Care provision is entirely public. According to the IGAS-IGA report, the Agence de santé has about 50 beds (42 at the Sia hospital, on Wallis, including 13 surgical, 14 medical, 14 gynaecology-obstetrics and one intensive care bed; 9 at the Kaleveleve hospital, on Futuna), four first-line dispensaries (three on Wallis, one on Futuna), an imaging department (X-ray, ultrasound, scanner) and a laboratory. Emergency services operate 24 hours a day at both sites. Staffing is small (seven hospital doctors and eight general practitioners) and ophthalmology, ENT, cardiology, rheumatology, gastroenterology and psychiatry are only provided by temporary missions of specialists from Nouméa or mainland France.

The same report describes worrying health indicators (high prevalence of diabetes and obesity) and a weakened governance of the Agency, with a social movement in September 2024 that disrupted access to care. When local care is not possible, the patient is evacuated by air to New Caledonia, mainland France or, more rarely, Australia; the archipelago is more than 16,000 km from mainland France and 1,870 km from New Caledonia.

• Entry and stay: Wallis and Futuna is part of the French Republic. A French citizen does not need to request a visa or residence permit to settle there; as the international air link goes through Nouméa or Fiji (only international airport: Hihifo, on Wallis), the identity documents required at boarding are to be confirmed with the airline and the State services on site.
• Local health insurance affiliation: not applicable, there is none. No local health insurance contribution is levied; the territory's Caisse des prestations sociales manages the basic pension, family benefits (including maternity leave allowance) and child welfare.
• Free care: it is guaranteed to residents of the territory. The sources consulted do not define the notion of resident or the treatment of a mere visitor: to be checked with the Agence de santé before departure.
• Cover outside the territory: the State website for Wallis and Futuna points out that the absence of a health insurance fund raises the question of coverage outside the archipelago, and strongly advises paying into a supplementary scheme for any trip. The Agence de santé covers the evacuations it prescribes, not care chosen by the person during personal travel.
• On return to mainland France: ameli states that the territory is not among those linked to mainland France by a bilateral agreement and that affiliation is under ordinary law, with the condition of stable and regular residence (three months, unless attached to an already insured spouse).
• Maternity: according to ameli, the cost of maternity care incurred in Wallis and Futuna is not covered by the primary fund; enquire with the territory's Caisse des prestations sociales.
• Student: an assignment or studies in Wallis and Futuna do not open entitlement to the European Health Insurance Card, as overseas countries and territories do not apply EU regulations. For study stays outside the territory, a student insurance remains to be considered.
• Civil servant or seconded staff member : ameli states that a civil servant posted to Wallis and Futuna must keep their Carte Vitale to be covered during stays in mainland France; the IGAS-IGA inspection mission notes that the arrangements for covering seconded civil servants during their stay in mainland France leave "blind spots".

No individual fine linked to lacking insurance is mentioned in the sources consulted. The risk is above all financial as soon as one travels outside the territory: the coverage of assistance and repatriation is not guaranteed by the local scheme.

Wallis and Futuna is not a foreign country: the archipelago became an overseas territory after the referendum of 27 December 1959, and Law no. 61-814 of 29 July 1961 gave it its status, today that of an overseas collectivity. There is therefore no social security agreement with France. According to ameli, the territory is not among those that have signed bilateral agreements with mainland France, and, according to one of its advisers, overseas countries and territories do not apply the EU coordination regulations.

• Health competence: it lies with the State, which funds all of the Agence de santé's expenditure; the Caisse des prestations sociales only covers, according to IGAS, the old-age and family risks, and strengthening the territory's social protection is among the avenues mentioned by the mission.
• Evacuations to New Caledonia: the Agence de santé pays New Caledonian establishments for care, and a debt of €21.5 million had been built up towards them at the end of 2014, since repaid through a loan from the Agence française de développement.
• Evacuations to mainland France: the State website for Wallis and Futuna mentions an agreement with the Assurance Maladie providing for the provisional registration of patients on arrival in Paris; its current status should be checked with the Assurance Maladie.
• State retirees: the State pensions service's page on health cover deals with pensioners residing in French Polynesia, New Caledonia or Wallis and Futuna, but names a local body only for the first two territories, which have a health insurance scheme.

1. Before departure: report your departure to French bodies (primary health insurance fund, CAF, France Travail, pension funds) and ask your fund what it maintains or suspends, in particular for a civil servant (keeping the Carte Vitale).
2. Contact the Agence de santé of Wallis and Futuna to learn the conditions for access to free care (notion of resident) and the medical evacuation procedure.
3. Take out supplementary insurance covering care outside the territory (mainland France, New Caledonia, abroad), as advised by the State website for Wallis and Futuna.
4. Plan for assistance and repatriation for journeys: the archipelago is served from Nouméa or Fiji, with two weekly flights (three during school holidays) according to IGAS.
5. Employee or employer: contact the Caisse des prestations sociales of Wallis and Futuna for retirement, family benefits and maternity leave.
6. Retiree: ask your pension fund and the State pensions service for the procedure applicable to residence in Wallis and Futuna.
7. On return to mainland France: apply for affiliation to the primary fund of your place of residence, enclosing the birth certificate if no social security number exists, taking into account the three-month residence condition.