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France’s health insurance scheme has updated its classification of chronic fatigue, no longer referring to the illness as a “psychiatric or psychological disorder,” on its website
The update to the information page on the Ameli (website for state health insurance body Assurance Maladie) has been welcomed by campaigners
The illness is now described as “a disease causing debilitating chronic exhaustion and a worsening of symptoms following minor exertion,” and the website adds that it “should not be considered a psychological disorder.”
An increase in cases following the Covid-19 pandemic means anywhere between 700,000 to one million people in France suffer from chronic fatigue, for which there is no known cure
Pre-Covid estimates of the illness were around 200,000 sufferers in France.
However, many cases go undiagnosed
Change welcomed by associations
“This institutional recognition is a significant milestone,” said the French Association for Myalgic Encephalomyelitis and Systemic Exertion Intolerance (AFEMISE, Association française de l’encéphalomyélite myalgique et des intolérances systémiques à l’effort) to media outlet France Inter.
It praised the fact that Assurance Maladie “specifically recognises post-exertional malaise as a core symptom, acknowledges varying levels of severity, and accepts the importance of pacing (energy management) as well as the risks associated with graded exercise programs”.
There are hopes that the change will make it easier for sufferers to receive help, as “psychologisation of the disease” is a common barrier for diagnosis, said AFEMISE president Pietro Tomé to France Inter.
Symptoms of the illness listed by Assurance Maladie include:
Profound, debilitating fatigue that has been chronic for several months, is unexplained, and is not relieved by rest or sleep
Cognitive impairment
Difficulty remaining upright
Orthostatic intolerance
However, it also stresses that there are numerous other possible symptoms that “bear no apparent connection to one another, vary from patient to patient, and fluctuate from day to day.”
The change brings France more closely into line with the UK, where ME/CFS is not considered a psychological condition and patients are advised to manage their activity levels carefully to avoid worsening symptoms.
The US Centers for Disease Control and Prevention also explicitly describes ME/CFS as a “biological illness affecting many body parts”.
No additional reimbursement
Despite the changes and acknowledgement that the disease can impact patients for an extended period, the update has not come alongside a change in classification for the illness.
It has not been added to France’s official list of long-term illnesses (Affection Longue Durée, ALD), sufferers of which benefit from additional health insurance coverage.
It means that appointments related to chronic fatigue with a GP or general doctor continue to be covered at 70% for holders of a carte Vitale, with the remaining amount covered by a mutuelle if the person has one.
Reimbursement levels may differ for appointments with specialists.
