2024-04-15 02:30:05
We were more than 3,000 caregivers to call for the maintenance of State medical aid (AME), on November 2, 2023, twenty-three structures and learned societies to defend this system, on November 28, and more than 7,500 caregivers signatories the day after the vote on the immigration law at the end of December.
On the eve of an announced reform, we, health professionals, are once again calling for the defense of the AME against any reduction risking degrading its content and, by extension, the French healthcare system. We would like to remind you that people without health coverage are more often than others in care at more advanced stages, at the risk of increasing the saturation of the health system and the cost of care.
The AME allows people in an irregular and precarious situation to access care. Since its creation in 1999, this system has been the subject of several reforms, reducing its access and its scope. Although the plan to replace it with emergency medical aid has been ruled out, the government has committed to reforming it in 2024 based on the conclusions of the Evin-Stefanini report. Claude Evin, former Minister of Health, and Patrick Stefanini, State Councilor, agree on several key points.
The first is that if there is indeed an increase in AME expenditure correlated with the increase in the number of beneficiaries, “the average quarterly consumption per beneficiary has remained stable over the last fifteen years, despite the increase in the cost of care over the period” − with 642 euros in 2009 compared to 604 euros in 2022, a drop of almost 6% in a context of inflation of almost 30%. In total, 968 million euros are devoted to this system, or 0.5% of the Health Insurance budget.
Restricted scope
The second is that the SOUL is “the service managed by Health Insurance with the highest control rate”making it possible to drastically limit the risk of fraud (less than 3% of anomalies observed).
The third is that the available data contradicts the idea that the AME is a factor of attractiveness 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, particularly relating to the resource ceiling.
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The fourth is that if the SOUL is “a system correctly framed in regulatory terms and largely operational”its restricted scope, excluding in particular its beneficiaries from the “treating doctor” system and screening campaigns, affects “the fluidity and efficiency of the care pathway”. There is, moreover, a radical threshold effect: any person whose resources exceed the ceiling of 810 euros per month is excluded, including undocumented workers whose contributions nevertheless contribute to the financing of Health Insurance. Added to these limits is a risk of discrimination (14% to 36% less chance of having an appointment with the general practitioner) and a worrying level of non-recourse (50% of eligible people do not have one not).
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