Dr Sylvie Da Lomba on health care charges for undocumented migrants in France

By Dr Sylvie Da Lomba,
University of Strathclyde, Law School, Glasgow, UK.


Until recently, undocumented migrants who had been residing in France for at least three months and whose resources did not exceed 634 Euros per month were eligible for free health care under the Aide Médicale d’État (AME). From March 2011, however, access to health care will cease to be free and AME beneficiaries will have to pay a 30 Euros annual fee. This measure constitutes yet another step in the tightening of admission conditions to the AME.

Previous reforms of the AME have all been justified by the need to control and rationalise public expenditure and the same rationale has been used in respect of the present reform. In July 2010, the French Health and Budget Ministers commissioned a report on the reasons for the increase in AME expenditure. Subsequently the Government put forward a proposal for the introduction of an AME annual fee. The proposal was passed by the French National Assembly in December 2010 and is due to come into effect in March 2011. At this juncture, it would be reasonable to make the following assumptions: that the annual fee will help reduce, or at the very least control, expenditure; and that the reform was informed by the findings of the report commissioned by the French Government. Yet we would be wrong to make such assumptions.

The report strongly advises against the introduction of a fee and stresses that this could prove costly for the State. The report notes that savings would be minimal (6 million Euros at best) and warns against the likely ‘substantial perverse effects’ of the proposed measure. In particular, it warns against increases in hospital bills. It is well-established that health care charges tend to deter the poorest groups of society, which include undocumented migrants, from seeking treatment. Charges often mean that medical care is sought at a late stage, generally from hospitals, which makes it more expensive. Proponents of the reform put much emphasis on the need to prevent abuses. Yet the report clearly indicates that increases in AM expenditure could not be attributed to abuses. The report also points out that constraints on access to health care arising from charges pose a threat to public health.

It is clear that this new measure is not about reducing expenditure. The latest reform of the AME is about being ‘tough’ on undocumented migrants, irrespective of costs. The introduction of an annual fee will constrain undocumented migrants’ access to health care and consequently the realisation of their human right to health care. It will also detrimentally impact on France’s finances and on public health. The French Government’s reluctance to develop evidence-based laws and policies and its eagerness to perpetuate unfounded negative assumptions about undocumented migrants are particularly worrying. Significantly the report was only made available online once the proposal had been passed by the national Assembly. This determination of the French Government to be ‘tough’ on undocumented migrants irrespective of the consequences does not bode well for the protection of undocumented migrants’ basic rights in France.

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