3 QUESTIONS TO... :

1/ What impact does the State Medical Aid scheme have on access to healthcare for undocumented immigrants?

Our research shows both a decline in non-use of healthcare services, and an increased use among the persons covered, for equivalent healthcare needs. These effects are not linked to a pent-up effect, i.e. an increase in initial consumption among the recently covered and are significant over time. The State Medical Aid scheme indeed appears to improve access to healthcare services, which is its primary objective.

2/ Did you monitor a change in the use of specific healthcare services, especially Emergency Departments (ED)?

The longer the length of the State Medical Aid coverage, the greater the likelihood of consulting a doctor in a medical practice or a health centre, while the use of seeking care in ED or NGOs decreases. State Medical Aid thus favors a form of acculturation to the healthcare system, and to healthcare pathways more conducive to prevention and proper management of chronic diseases. This scheme favors outpatient treatment rather than using the emergency services is in line with the goals of the French healthcare system reform "Ma Santé 2022" ("My Health 2022").

3/ What are the main lessons to be learned from French and foreign experience with State Medical Aid or equivalent schemes abroad?

First of all, health reasons play little part in migration decisions. All our results support that State Medical Aid does not induce significant immigration for health reasons. Secondly, and this is undoubtedly the main finding of our work on State Medical Aid, half of those eligible remain uncovered and these include people in poor health. Improving access to State Medical Aid should therefore be a central element of any reform of this scheme. Reducing the State Medical Aid basket of services to emergency care only, as is the case in some European countries, would not guarantee a decrease in healthcare costs for undocumented immigrants, but would very probably have a deleterious impact on their state of health, as has been shown elsewhere (Jimenez-Rubio, 2020; Mestres et al., 2021).