While some presidential candidates suggest removing the AME, Why Doctor is revisiting this device.
During the first presidential election debate, the candidates only scratched the surface of health issues. Barely two minutes were devoted to health issues, but enough to evoke what appears to be a concern among at least two contenders for the supreme office: state medical aid (AME), considered too expensive, too generous, obsolete . Back in figures and facts on this social benefit.
In place since 2000
It is intended for foreigners living in France in an irregular situation, for whom it provides access to medical care. To be eligible, you must have resided for more than three months in France without a residence permit and not earn more than a certain amount. It applies everywhere on the territory, with the exception of Mayotte.
Granted for a period of one year, the AME gives the right to 100% coverage of medical and hospital care, within the framework of Social Security tariffs. However, drugs with a low reimbursement rate (15%) or even medically assisted procreation aids and thermal cures are not covered.
The AME was established in 2000 under the government of Lionel Jospin to replace Free Medical Aid. Three types of AME are applicable (common law, emergency, others). The principle behind it is both philosophical (Hippocratic oath, principle of medicine that treats everyone without conditions) and pragmatic (early treatment of diseases to avoid emergency situations, prevention of pathologies , limiting their prevalence, reducing the risk of contamination, etc.).
831 million in 2014
In 2015, this social benefit was budgeted in the finance law at 678 million euros for nearly 300,000 beneficiaries. This represents 0.45% of all health expenditure in France, established at 159.2 billion euros in benefits paid by the health branch of Social Security the same year. The majority of beneficiaries are men under 34, but pregnant women are also over-represented.
In 2014, the AME cost 831 million euros, while a budget of 605 million euros had been foreseen. The regular underestimation of the budgets devoted to this aid in the finance laws generates a criticism of the merits of this device. In 2016, it was budgeted at 744.5 million euros.
Source: Senate Finance Committee
The costs and the number of beneficiaries are on the rise, which also grounds the grievances of some presidential candidates, at around 5% per year. This can be explained by the increase in the number of asylum seekers in France and by the refusal rate to issue residence permits (around two out of three applications), which produce as many applicants for AME.
As for fraud, another argument raised to denounce this service, it does not seem to be the cause of the increase in costs. In a parliamentary report led by deputy LR Claude Goasguen, we can read that “fraud does not explain the growth in expenditure”, a finding shared in a previous report from IGAS. All the more so since many beneficiaries of AME do not ask for this help, often by ignorance of their access to this right.
The divided candidates
Among the candidates, two lines are opposed concerning the future of the AME. : some want to perpetuate it when others want to repeal it. Marine Le Pen, Nicolas Dupont-Aignant are part of the second camp; François Fillon proposes to reserve it for infectious diseases and the others wish to keep it as it is, without restricting its conditions of access.
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