A study on undocumented immigrants' access to care and insurance


First Steps Survey: The field research has started

4 mars 2019


Paul Dourgnon, Florence Jusot, Clara Lemonnier, Stéphanie Guillaume, Antoine Marsaudon, Jérôme Wittwer


Pre-survey and structural sampling: December 2018 - January 2019

Survey of undocumented immigrants: February 2019 - April 2019


Paris and Bordeaux


  • University of Bordeaux
  • Institut de santé publique, d'épidémiologie et de développement (ISped), (Institute of Public Health, Epidemiology and Development, University of Bordeaux), Cassiopeia platform
  • Bordeaux Population Health, Inserm UMR 1219, EMOS Team
  • Fondation des amis de Médecins du monde (Foundation of the Friends of Doctors of the World)
  • Institut régional du travail social Aquitaine (Aquitaine Regional Institute of Social Work)


The First Steps survey (Enquête Premiers pas) is part of a research project on the paths of access to rights and healthcare for undocumented immigrants.

The project, which is supported by the French National Research Agency (2015 Generic ANR Call for Projects ) proposes through a socio-anthropological approach a survey of undocumented immigrants. This survey, combined with the use of administrative data, addresses the following questions:

  • What is the real access to healthcare and health insurance for undocumented immigrants in France? In particular, what are the favourable factors and barriers to the use of State Medical Assistance (AME, Aide médicale d'Etat), health centres of associative structures, public health care, or other caregivers?
  • What are the pathways of undocumented immigrants in terms of insurance (AME, basic universal health insurance (CMU) / Universal health protection, Public insurance, non-insurance) and in terms of use of healthcare services?

IRDES is responsible for the survey of undocumented immigrants. The First Steps survey will collect information on the migration path, health status, access to rights and insurance and use of healthcare services. It will be carried out in the metropolis of Bordeaux and in Paris. Part of the sample will be re-investigated after six months.

State Medical Assistance (AME, Aide médicale d'Etat)

The State Medical Assistance (AME) is a public health insurance system created in 2000 for people who cannot access a social security scheme because of their irregular situation on the territory, or in the absence of other coverage in the case of unaccompanied foreign minors. The AME may be granted by the French Local Health Insurance Funds (CPAM, Caisses primaires d'assurance maladie) to adults who can prove that they have lived continuously on the French territory for more than three months; it is subject to income conditions.

The AME provides the reimbursement - without advance payment - of the bundle of care covered by the French National Health Insurance Fund, with the exception of thermal cures, medically-assisted procreation and drugs with a low therapeutic value.


The survey is designed in collaboration with the anthropologists of the UMR 5319 PASSAGES team and with Médecins du monde (Doctors of the World), which coordinates a network of Health care centres (CASO) receiving many undocumented immigrants. Médecins du Monde also produces its own survey of its users, via the MDM observatory (observatoire MDM).

Sampling will be carried out in two stages. A first sampling will aim to constitute a sample of places and structures likely to be frequented by undocumented immigrants. Information on attendance will be collected in a pre-survey of the facilities. In a second stage, we will interview a sample of undocumented immigrants in the selected places.

Participation in the survey will be free and anonymous. No information will be transmitted to any administration. The information collected in the survey will only be used by researchers. It will be carried out under the supervision of the CNIL, which guarantees respect for anonymity, privacy and the protection of personal data.