3 questions to… Paul Dourgnon, Florence Jusot and Jérôme Wittwer following the publication of the three Issues in Health Economics (243, 244, 245), on the first results of the "Premiers Pas" survey on access to healthcare and to State Medical Aid (AME) for undocumented immigrants on the French territory.

December 2019

1/ How did this survey come about ?

Since the creation of the State Medical Aid scheme (AME, Aide médicale de l'Etat) in 2000, no statistical survey had been carried out to analyse this policy from the point of view of access to rights and access to healthcare for the people it was intended to protect. However, other policies such as the Complementary Universal Health Insurance (CMU-C, Couverture maladie universelle complémentaire), created at the same time as the AME, or the Health Insurance Vouchers Scheme (ACS, Aide à l'acquisition d'une complémentaire santé) were and still are the subject of numerous studies. It is a fact that AME accounts for only about 0.5% of health expenditure, but it has nevertheless become an important and sometimes divisive issue in the public debate, where it is the only public health insurance that is contested, while the principle of public health insurance under common law - the Social security - is widely accepted. This is why we have built this multidisciplinary project, where anthropological and economic approaches intersect, with this "Premiers Pas" survey in particular. Who and how many people actually have access to AME and why? What is the real access to health services of persons covered by AME? These are the main questions this survey attempts to answer.

2/ What does the survey of people eligible for State Medical Aid (AME) tell us?

First of all, the survey tells us that half of those eligible are not covered by AME. Surprising if we consider the rhetoric that migrants are attracted by the possibility of free healthcare. Less so if one considers the high rates of non-take-up of CMU-C or ACS. It should also be noted that only 10% of the people in the population we study cited health as one of their reasons for migration. So rather than a rush to AME, there is a high level of non-take-up among undocumented immigrants eligible for AME.

3/ However, can we think that this level of access is low because only a proportion of immigrants, in poor health, in need of care, take up State Medical Aid while the rest of this population is finally young and healthy?

No. A large proportion of people reporting health problems as serious as infectious diseases, or diabetes, are not covered. What primarily determines the level of coverage is the length of stay and the knowledge of French, in other words the ability to interact with the health system. Even among people who have been in France for more than five years, almost a third continue to be uncovered.

Interview by Anna Marek