“We, health care professionals, once again call for the protection of state medical care”

NoWe were more than 3,000 caregivers to call for the maintenance of public medical assistance (AME), on November 2, 2023, twenty-three structures and learned societies to protect this system, on November 28, and more than 7,500 caregivers signed the following day. Vote on immigration law in late December.

On the eve of the announced reform, we, health professionals, once again call for the protection of the AME from any cuts that threaten its content and therefore the French health system. Recall that people without health care coverage are more likely to be in more advanced stages of care, at risk of saturating the health care system and increasing the cost of care.

AME allows people in irregular and uncertain situations to receive assistance. Since its inception in 1999, this system has undergone several reforms that have reduced its accessibility and scope. Although a plan to replace it with emergency medical care has been ruled out, the government has committed to reforming it in 2024 based on the findings of the Evin-Stephanin report. Claude Evin, former Minister of Health, and Patrick Stefanini, Councilor of State, agree on several key points.

The first is that if there is indeed an increase in AME costs associated with an increase in the number of beneficiaries, “Average quarterly consumption per beneficiary has remained stable over the past fifteen years, despite an increase in the cost of care over this period” – 642 euros in 2009 compared to 604 euros in 2022, a drop of almost 6% with inflation of almost 30%. In total, 968 million euros, or 0.5% of the health insurance budget, are allocated to this system.

limited scope

The second is that there is a soul “Service managed by health insurance with the highest control rate”which will make it possible to drastically limit the risk of fraud (less than 3% of detected anomalies).

The third is that the available data contradict the idea that AME is an attractive factor for immigration candidates. It is not the most generous system in Europe: several neighboring countries offer a wider basket of care or with fewer access restrictions, especially regarding resource ceilings.

The fourth is that if there is a soul “A system that is well-designed from a regulatory point of view and largely functioning”Its limited scope, especially the exclusion of beneficiaries from the “treating doctor” system and screening campaigns, affects “Fluidity and efficiency of the care pathway”. In addition, there is a radical marginal effect: anyone whose resources exceed the threshold of €810 per month is excluded, including undocumented workers whose contribution still helps to finance health insurance. These thresholds are compounded by the risk of discrimination (14% to 36% less chance of getting a doctor’s appointment) and the alarming level of non-targeting (50% of eligible people do not).