Access to healthcare in France: PICUM consulted amidst concerns of new restrictions

PICUM’s Director Michele LeVoy was heard last week by the French social affairs and finance inspectorates on the issue of access to health care for undocumented people. The hearing is part of an inquiry by the French Inspection générale des affaires sociales, IGAS (Inspectorate General for Social Affairs) and Inspection générale des finances, IGF (Inspectorate General for Finance) evaluating the financial sustainability of the Aide médicale d’Etat or AME, the French scheme that provides access to health care for undocumented people.

Civil society organisations in France fear that this exercise is likely to result in the tightening of the AME, restricting access to health care for people already facing significant precarity. Concerns about such plans have been growing over the last couple of months and have received increasing media coverage on national newspapers, with a major political debate approaching on France’s migration policy, to be co-chaired by the Minister of Health and the Minister of Interior.

For 20 years, France has had in place legislation that provides comprehensive health coverage for people in an irregular situation, making it one of a handful of European countries, such as Belgium, Italy, and Spain, where there has been a genuine effort to achieve universal health care, leaving no one behind.

In the country, health insurance is mandatory and over 90% people are covered by the public health insurance. Undocumented migrants, however, cannot benefit from health insurance – but those who have resided more than three months in France and whose monthly income is less than 720 € are entitled to AME.

AME provides free access to nearly all healthcare services available to French nationals, including care related to sexual and reproductive health such as pregnancy, delivery, family planning, contraception and abortion. A reported 300.000 people benefit from the AME, at a cost of just 0,3% of France’s total health budget.

The AME, like every system, has its shortcomings. For instance, each French administrative area (département) varies in how it applies the regulations around eligibility for AME and can decide which documents it will accept to prove the residence and financial eligibility requirements. And very little effort is made to promote awareness among target populations of the rights under the AME.

Still, the French model remains an important example in Europe of universal health coverage that does not discriminate, based on a person’s residence status. Public health strategies should not vary based on arbitrary categories. France joined other member states of the World Health Organisation which adopted a resolution on migrant health in 2008 and 2018, and a strategy and action plan in the European region on migrant health in 2017. It has also committed to achieving truly universal health care by 2030, under the Sustainable Development Goals. Restricting the AME would represent an alarming step backwards for a country with a long history of promoting human rights and equality.

PICUM has, since our very beginning, been campaigning for access to health care for everyone, regardless of residence status. Health is a human right, and we are all diminished when distinctions are made between people when it comes to accessing essential services. Inclusive policies are also good for public health, emphasising prevention and health promotion, improving outcomes for children, families and communities, and reducing the costs of treating health emergencies that could have been mitigated or avoided through early intervention. Restricting access to health care based on residence status violates medical ethics, forcing health professionals to prioritise administrative eligibility requirements over their duty to first do no harm.

The French inspectorate IGAS is expected to table its report on the AME in the course of October, when it will be discussed by the two chambers of the French parliament.

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