No, State Medical Assistance does not encourage health-related migration

Paul Dourgnon, Florence Jusot, Antoine Marsaudon and Jérôme Wittwer, economists

State Medical Assistance is frequently blamed for the coming of irregular migrants to benefit from France’s healthcare services However, health-related reasons are only mentioned by 9.5% of undocumented migrants, such reasons have little correlation with the AME and healthcare take-up rates.

The State Medical Assis­tance (Aide Médi­cale d’État or AME) is a public insu­rance scheme which provides access without out-of-pocket expenses to most heal­th­care services for undo­cu­mented migrants. The AME remains at the centre of heated public debates. One frequently raised objec­tion to the scheme is that undo­cu­mented migrants come to France to take advan­tage of the health system”.

The First Steps Survey (Enquête Premiers Pas), carried out in 2019 amongst a repre­sen­ta­tive sample of undo­cu­mented migrants, sheds light on a different story. First of all, only 9.5% of them mention health as a reason for coming to France. Further­more, only 51% of eligible undo­cu­mented migrants are covered by the AME. The main factor explai­ning the use of the AME is not pre-exis­ting health condi­tions nor the motive for coming to France, but the length of stay in France. Although access to AME increases along with the time spent in France, even after 5 years of remai­ning in France, 34.6% of undo­cu­mented migrants remain uncovered.

The suppression of the AME would have very little effect on migratory flows. On the contrary, it would aggravate the already precarious situation of undocumented migrants.”

Paul Dour­gnon, Florence Jusot, Antoine Marsaudon and Jérôme Wittwer, economists

The immi­grant’s health in their country of origin appears to have little to do with the acqui­ring of the AME. Amongst the people whose illness had already been diag­nosed in their country of origin, 48% are not covered by the AME. Addi­tio­nally, within the 9.5% that have reported coming to France for medical purposes, 28.5% are not covered by the AME. Ulti­ma­tely, the use of heal­th­care services by sick irre­gular migrants remains low. Within a year, two-thirds of undo­cu­mented immi­grants that have declared coming to France for health-related reasons, have consulted a general prac­tice and a quarter turned to a hospital.

Conse­quently, the suppres­sion of the AME would have very little effect on migra­tory flows. On the contrary, it would aggra­vate the already preca­rious situa­tion of undo­cu­mented migrants in France.

Further readings

About the authors

Paul Dour­gnon is a Research Director at the Institut de Recherche et Docu­men­ta­tion en Économie de la Santé (Irdes).

Florence Jusot is Professor of Econo­mics at PSL, Univer­sité Paris-Dauphine, affi­liated with the Labo­ra­toire d’Éco­nomie et de Gestion des Orga­ni­sa­tions de Santé (Leda), and an Asso­ciate Resear­cher at Irdes.

Antoine Marsaudon is a Research Fellow at Irdes.

Jérôme Wittwer is Professor of Econo­mics at the Univer­sity of Bordeaux, Bordeaux Popu­la­tion Health, Inserm U1219.

Cite this article

Paul Dour­gnon, Florence Jusot, Antoine Marsaudon and Jérôme Wittwer, “No, State Medical Assis­tance does not encou­rage health-related migra­tion“, [trad. Victoire Hernandez], in Betty Rouland (Ed.), Issue “State Medical Assis­tance and the making of a fake problem”, De facto [Online], 31 | February 2022, [English] publi­shed online in February 2023. URL :–04/


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