This carte vitale—the “vital card,” or the “card of life”—contains the patient’s entire medical record, back to 1998. Embedded in the gold metallic square just left of center is a digital record of every doctor visit, referral, injection, operation, X-ray, diagnostic test, prescription, warning, etc., together with a report on how much the doctor billed for each visit and how much was paid, by the insurance funds and by the patient. Everybody in France over age fifteen has this card—a child’s medical records are maintained on his mother’s card—and it is the secret weapon that makes French medical care so much mor efficient than anything Americans are used to. When Dr. Bonnaud receives the carte vitale from his patient, he slides it into a small reader on top of his desk—it’s about the size of a desktop telephone—and the patient’s medical record is displayed on the doctor’s computer screen. That’s why French doctors and hospitals don’t need to maintain file cabinets full of records. It’s all digitized. It’s all on the card. As Dr. Bonnaud considers his patient’s symptoms and proposes a remedy—a shot, a course of drugs, a referral to a specialist, a good night’s sleep, whatever—he types in a record of the visit and his treatment. That information is written to the patient’s carte vitale. If the patients if advised to go to the hospital or a specialist or drugstore, he will take his carte vitale along with him, and on it the doctors there will find Dr. Bonnaud’s diagnosis and recommended treatment. (With 50 million green cars floating around, a thousand or more get lost every week somewhere in France. If you find a lost card, you’re supposed to drop it in any mailbox, and it will be forwarded to the national Centre des Cartes Vitale Perdues, in Le Mans. The Centre says about 80 percent of lost cards eventually get back to the owner.) Because the medical information on that gold chip is encrypted, France’s Health Ministry insists that there have been no breaches of patient privacy.
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