english.prescrire.org > Spotlight > Archives : 2011 > France's "AME" programme to cover uninsured foreigners: restrictions contravene medical ethics and are detrimental to public health

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France's "AME" programme to cover uninsured foreigners: restrictions contravene medical ethics and are detrimental to public health

In France, the recipients of a government aid programme known as AME ("Aide médicale d’état") must now pay a contribution to benefit from the scheme. This measure serves no financial purpose but restricts access to care and endangers public health.

France's "AME" aid programme guarantees free access to healthcare for certain non-French nationals. Recipients must have been continuously resident in France for over 3 months, but not have a residence permit; their income must be below the threshold set for France's universal health insurance coverage known as (CMUc), which is 634 euros a month for a single person.

On average, healthcare spending for beneficiaries of AME is similar to that for the general population. In 2009, 267 000 people benefited from AME, accounting for an expenditure of  540 million euros. The beneficiaries were predominantly men, 80% of whom live alone, and whose state of health is poorer than that of people of the same age who have healthcare coverage.

A 2010 joint report by France's General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of Finances shows that the increase in AME spending in 2009 was not due to a rise in the number of beneficiaries, nor to fraud or misuse, nor to more frequent recourse to care, but to differences in the national health insurance system’s accounting practices.

Without waiting for this report, and despite objections from charitable groups, healthcare professionals and several members of the French parliament, the government introduced into its 2011 budget an annual fee of 30 euros for an adult to enter the AME system, as well as a system requiring prior approval for costly planned inpatient treatments.

The Inspectorate's report emphasises that making AME beneficiaries contribute financially serves no purpose, and has proved to be a dangerous obstacle to access to care, putting these patients and the general population seriously at risk.

Prescrire demands that this measure be abolished, and, meanwhile, urges healthcare professionals to help these patients and the charitable groups that act in their defense.

©Prescrire 1 October 2011

"France's AME : medical apartheid" Prescrire Int 2011; 20 (120): 249. (pdf, free)
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