Nobody wants to go the hospital, but for expats it's an especially stressful time: there is perhaps no other facet of human society in which cultural values manifest themselves in more surprising and upsetting ways than in how we care for our sick and wounded...

...but that's a subject for another time. Here's how it went down (with particular attention to costs, since that is usually at the heart of any health care debate).

1) Yours truly had a dastardly case of varicose veins, the kind that can only be fixed through good ol'-fashioned vein stripping. For a set of reasons that aren't important here, I decided to have it done this fall; during my last physical, I asked my GP to refer to me to a good vascular surgeon.

2) I made an appointment to see the surgeon, for which there was about a two-week wait. I saw him in August: he took a look, agreed that I was a good candidate for the surgery, gave me a stack of paperwork and an appointment at the hospital in October (my choice: he was ready to do it right away but I wanted to finish the running and riding seasons first). (cost: €65, €40 reimbursed by France's single-payer health care provider)

3) Late September: appointment with the anesthesiologist. (cost: €60, €35 reimbursed)

4) Early October: blood tests at local accredited testing center. (€27, €15 reimbursed)

5) Mid-October: visit to pharmacy to purchase prescription compression bandages, compression stockings and leg-hair removal cream (mmm, leg hair removal cream...). (€175, €70 reimbursed)

6) T-1 day: visit to the vein doctor, who ultrasounded my legs to make sure all deep veins were functioning properly and then road-mapped the veins scheduled for destruction with an indelible magic marker. (€75, €45 reimbursed)

7) 18 October: I check into the private hospital Lyon Mermoz at 7 am, take my anti-bacterial shower, roll into the OR around 8:30 and wake up in a nauseous haze around 12:30. Someone feeds me around 2:00. A nurse comes to my room (a double, but I was lucky enough not have a roommate) around 3:30, unwraps me, cleans all the wounds (around 50 of them) and re-wraps my legs with the contention bands I bought at the pharmacy. Then the surgeon stops by to tell me how awesomely the surgery went, which I appreciated. I leave the hospital that evening around 7 with prescriptions for low-end pain pills and anti-coagulant shots to be administered by a nurse in my home once per day for ten days. On the way out, we pay. (hospital time, surgeon's fees and anesthesiologist's fees: €1135, €537 reimbursed)

8) For ten days, the nurse comes by to poke me with a needle each afternoon. On the tenth day, she will remove the stitches from the eight wounds that required them. (cost: €250, €175 reimbursed)

9) During the fifth day of recovery, I have so much pain in one calf that I fear the dreaded deep-vein thrombosis: I call the vein doctor, who sees me immediately and ultrasounds me into believing that I do not have any DVTs. (€36, €20 reimbursed)

10) Sometime in December, I will go see the surgeon again for a final analysis of his work. (€65, €40)

And there you have it!

Analysis

In terms of the actual experience, I have to admit that this has been one of the most painful and challenging periods of my life: vein stripping is barbaric and not at all fun, and my case was particularly advanced. This fact notwithstanding, however, I've got nothing to complain about: every appointment and every detail of the procedure from start to finish was handled in a timely and professional manner, the hospital was clean and smoothly run by smiling people who seemed to be in the right line of work, and the anesthesiologist didn't turn me into a vegetable: what more can you ask for?

In terms of cost, the whole experience ran me about €900 "out-of-pocket," as the American catchphrase goes, but I could have had it done for much less: I chose to pay extra to have it done in a private hospital by a surgeon who does not work for the state hospital system and is free to set his own rates (France's health care system uses the single-payer, not the dreaded "socialized," model: if you need a refresher on the difference, check this out). Had I gone to a state hospital, the out-of-pocket number would have been more like €350. If I were unemployed, it would've been zero.

Also, my wife and I choose to not buy a mutuelle, or supplemental health insurance policy: if we did, it would have picked up 100% of my out-of-pocket fees for this surgery. To do so, however, we would have to pay around €125/month, and in years where I don't let a mad butcher carve several dozen holes in my legs that's much more than we generally spend.

And what do I pay to get this sort of service, i.e. how much does the mandatory state-administered health insurance cost? Difficult question, and the answer is that it's different for everybody: when you're really poor it's free and when you're really rich it's not, but on average most people see a small percentage of their gross pay going directly (and automatically) to health care costs: the last time I had a regular job in an actual building with a real-life employer, they took about €45/month for health care, with another (larger) chunk being paid by my employer. Now that I work in the virtual world it's weirder and harder to figure out, but I think in the end it's about the same.

Screaming pain in my calves notwithstanding, it sure seems like a good deal to me.