In Saint-Denis (Seine-Saint-Denis), the teams at the Delafontaine hospital agree. If state medical assistance (AME) were to disappear, it would be a catastrophe. The immigration bill passed in the Senate provided for its repeal. However, MPs in the committee restored this system ahead of the scheduled debate in the Assembly from December 11.

Public institutions are most affected by the consequences of a possible reform of this health care system, which, like the basic social insurance, is intended to take care of foreigners who have been in the territory with an irregular residence status for more than three months. And for good reason: in the heart of the poorest department in mainland France, 8% of patients in Delafontaine are covered by AME, compared to around 0.5% in other facilities. What happens if these exiles are no longer covered tomorrow?

Without AME, people without health insurance will rely more on hospital structures, where they can now rely on resident doctors like any other insured person. Some will also forego seeking treatment at the risk of making their situation worse and end up using the emergency system. Ultimately, the costs incurred by these patients remain the sole responsibility of the hospital, which will not be reimbursed by health insurance and whose deficit will increase.

0.5% of total Medicare spending

In Spain, where a system similar to AME was abolished from 2012 to 2018, a study showed that in the first three years without this support, the mortality rate of undocumented immigrants increased by 15%. “A removal of the AME would be likely to destabilize our economic model or compromise the protocol for caring for people, warns Jean Pinson, director of the Saint-Denis hospital center, on which the Delafontaine hospital depends. The AME allows us to enroll people in a standard care pathway that is less costly to the community and more efficient for them. »

Contrary to this observation, the Senate, dominated by the right and center, voted to abolish the system with the aim “Anti-fraud” and from “Stop the trend increase in AME spending”. In 2022, this corresponded to 1.186 billion euros, i.e. 0.5% of total health insurance expenditure, for around 411,364 beneficiaries.

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