Spa holidays in France: ‘taking the waters’ with a doctor’s prescription

From Italy to Germany, Spain to the Balkans, many cultures swear by the use of hot water for its curative properties. France sets itself apart from many European neighbours, however, as doctors can prescribe spa stays, meaning that those covered by the French national health care system can “take the waters” and be reimbursed.

While it may seem surprising that such treatments would be paid for by the state, taking a close look at concrete treatment practice of “thermalism” (as it’s called here), we found that it stands apart from the standard approach of simply soaking in hot springs to relax. Indeed, the French practice of spa treatments is a unique medical practice.

A brief history

The practice of enjoying hot springs goes back to the Romans, who introduced thermae baths. Today’s word spa is derived from the Latin “salus per aquam”: which means health by water. For them, bathing was a way of cleansing, relaxing, and purifying the body and was practiced regularly. With the Roman conquest of Gaul, half of today’s French thermae facilities are located on the site of former Roman baths, such as Aix-les-Bains. Yet despite their enthusiasm for bathing, Romans were not aware of the medical benefits behind the use of water in these places.

It wasn’t until the Middle Ages that the curative properties of certain waters were discovered. At that time, half-magical, half-medicinal springs were in use and recognised as a therapy in most countries of Europe, North Africa, and Southeast Asia.

The turning point came during the Renaissance, when France decided to legislate on the use of those fountains, and marked the beginning of thermae medicine, with the appearance of the first “thermal cures”, implementing new practices such as showers and drinking cures rather than just bathing. Scientific works from this period testify to the birth of a genuine therapeutic practice based on the virtues of specific types of waters.

Around the time of Napoleon, the practice was increasingly regulated as part of a therapeutic approach. Functional spas were built and thermalism reached its golden age with cities such as Bath, Vichy, and Spa. The end of the Second World War marked another turning point, with the French social laws introducing the reimbursement of the thermae cures by the social security: the actual form of water therapy that we want to focus on.

In Italy, Germany, Spain, and the Balkans, thermal waters are still popular today, but in the United Kingdom, Ireland, the Netherlands, and the Scandinavian countries, thermalism is not officially recognised. Thermal waters are still used, but only in the context of wellness, as in the famous [Blue Lagoon]

The English language thus lacks the proper translation of the French word thermalism, which can be understood as the medical practice of thermae. It is a close synonym of balneotherapy, crenotherapy, hydrotherapy, or spa therapy, yet thermalism has different characteristics, bringing together mineral resources, treatment techniques, prescriptions and follow-up.

French uniqueness

So why are “thermal cures” recognised and prescribed in France in the same way as other medical treatments?

The reason lies in the composition of the water. The waters used in the establishments are not just naturally warm and therefore pleasant and relaxing and, by extension, a bodily pleasure good for your health, they have specific mineral compositions that render them therapeutic.

Scientific studies have been carried out showing the results of using these waters for a wide range of conditions. They are recognised in the treatment of digestive, mucosal, urinary, dermatological, gynecological, cardio arterial, neurological, psychosomatic, phlebology, rheumatology, developmental, and respiratory disorders.

Depending on the composition of their spring, the establishments do not treat the same pathologies. For example, La Roche Posay water, which has a high selenium content is indicated for dermatological conditions, while La Bourboule water, which has bicarbonate and arsenic content, is suggested for respiratory conditions.

Such water sources are protected by law through a declaration of public interest that recognises their medical utility and protects them against any pollution or disturbance. It’s required that they reach patients directly from the earth, without treatment.

A person suffering from one of the covered conditions can be prescribed a thermal cure by a health professional, who will specify to the patient where to go for the water required. On arrival, the patient will be attended to by an on-site doctor, who will decide what treatment is best. The process is highly regulated, with four to six treatments per disease and set durations. Doctors carry out some of the treatments, such as Proetz drainage of nasal cavities, while others are carried out by physiotherapists.

Cures typically last three weeks, with treatments every morning except Sundays. Patients must therefore stay on site and take time off from work. While they’re reimbursed, such cures cannot be taken during sick leave. As the treatment is restrictive, the establishments have developed free one-week cures, but these are not reimbursed as the duration imposed for medical effectiveness remains 21 days.

Care varies greatly depending on the affliction. There are pool and bubble-based treatments and underwater massages, sometimes with mud wraps, which can still make us want to compare to a spa, but most of the treatments differ from this imagery and can be tedious if not painful, such as cavity irrigation. Due to the duration of the treatments and the hot and moist atmosphere, some patients suffer from fatigue or “thermal crisis”. In dermatology, for example, it is not uncommon for patients to experience a rebound effect from their condition, which can be difficult to cope with before the treatment protocol ends.

An example for the rest of Europe

Thermalism is thus very different from balneotherapy, thalassotherapy, and classic hot spring spas. It’s a strictly medical practice and thus cannot be compared to an afternoon at the Carolus baths in Aachen even though it is based on the same water source.

While cures at thermal facilities can obtain positive results, they are not without their critics, mostly in terms of cost. While detractors might see it as too costly for the state, it’s a tiny fraction of the country’s social security budget and is proven to lessen drug use and thus drug expenditure due to its effectiveness rendering patients to put a halt to their treatment thus in a way of saving the system’s money.

These effects have recently attracted the attention of the European Commission, which is looking at the possibility of allowing Europeans to take thermal cures to ease the after-effects of cancer treatment.