In Saint-Denis (Seine-Saint-Denis), the teams at Delafontaine hospital are unanimous. If state medical aid (AME) were to disappear, it would be a catastrophe. The immigration bill passed in the Senate provided for its removal. The deputies in committee, however, reestablished this system before the debate planned in the Assembly from December 11.
The public establishment is among the most exposed to the consequences of a possible reform of this health coverage intended to take charge – like basic social security – of the care of foreigners who have been in an irregular situation in the territory since more than three months. And for good reason: in the heart of the poorest department in mainland France, 8% of Delafontaine’s patients are covered by AME, compared to around 0.5% in other structures. If, tomorrow, these exiles are no longer covered, what will happen?
In the absence of AME, people without health coverage will resort more to hospital structures where, today, they can call on community doctors, like any other insured person. Some will also give up seeking treatment, at the risk of seeing their situation worsen and, ultimately, will request the emergency system. Ultimately, the expenses incurred for these patients will remain the sole responsibility of the hospital, which will not be reimbursed by Health Insurance and will see its deficit widen.
0.5% of total Medicare spending
In Spain, where a system similar to the AME was abolished from 2012 to 2018, a study showed that, during the first three years without this assistance, the mortality rate of undocumented immigrants increased by 15%. “A removal of the AME would be likely to destabilize our economic model or degrade the protocol for caring for people, warns Jean Pinson, director of the Saint-Denis hospital center, to which the Delafontaine hospital depends. The AME allows us to enroll people in a standard care pathway, less costly for the community and more efficient for them. »
Contrary to this observation, the Senate, dominated by the right and the center, voted to remove the system, with the aim of “fight against fraud” and of “Stop the trend increase in AME expenditure”. In 2022, these represented 1.186 billion euros, i.e. 0.5% of total Health Insurance expenditure, for some 411,364 beneficiaries.
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