3 questions to… Paul Dourgnon, Florence Jusot and Jérôme Wittwer, following the publication of the three Issues in Health Economics (243, 244, 245), November 2019: "Providing Healthcare Coverage to Undocumented Immigrants in France", "A Study of Undocumented Immigrants' Access to Health Coverage and Care in France: The Premiers Pas Survey", "Access to State Medical Aid by Undocumented Immigrants in France: First Findings of the Premiers Pas Survey".
Since the implementation of State Medical Aid (AME) in 2000, no statistical survey had analysed this policy from the point of view of access to rights and access to care for the persons it was intended to protect. However, other policies such as Complementary Universal Health Insurance (CMU-C, Couverture maladie universelle complémentaire), implemented at the same time as State Medical Aid, or Health Insurance Vouchers Scheme (ACS, Aide à l'acquisition d'une complémentaire santé), were and still are the subject of numerous studies. It is true that State Medical Aid represents only about 0.5% of health expenditure, but it nevertheless holds a significant and sometimes divisive place in the public debate, where it is the only public health insurance that is contested, while the principle of public health insurance under ordinary 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 are covered by State Medical Aid and why? What is the real access to health services of the State Medical Aid-insured? These are the main questions this survey attempts to answer .
First of all, the survey tells us that half of the persons who are eligible are not insured with State Medical Aid. Surprising if one sticks to the rhetoric that migrants are attracted by the possibility of having free care. Less so considering the high rates of non-take-up of Complementary Universal Health Insurance (CMU-C) or Health Insurance Vouchers Scheme (ACS). In fact, only 10% of the population we study mention health as a reason for migration. Thus, rather than a rush to State Medical Aid, a high level of non-take-up is observed among undocumented immigrants eligible for State Medical Aid .
No. A large proportion of persons 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, nearly a third continue to be uncovered.