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Just a question of time? Explaining non-take-up of a public health insurance program designed for undocumented immigrants living in France

Published online by Cambridge University Press:  05 August 2022

P. Dourgnon ,
F. Jusot ,
A. Marsaudon Open the ORCID record for A. Marsaudon [Opens in a new window] ,
J. Sarhiri  and
J. Wittwer
P. Dourgnon
Affiliation:
Institut de Recherche en Economie de la Santé (Irdes) – Research and Information in Health Economics, Paris, France
F. Jusot
Affiliation:
PSL, Université Paris Dauphine, Leda et Irdes, Paris, France
A. Marsaudon*
Affiliation:
Institut de Recherche en Economie de la Santé (Irdes) – Research and Information in Health Economics, Paris, France
J. Sarhiri
Affiliation:
Institut de Recherche en Economie de la Santé (Irdes) – Research and Information in Health Economics, Paris, France
J. Wittwer
Affiliation:
Université de Bordeaux, Bordeaux Population Health, Bordeaux, France
*
*Corresponding author. Email: marsaudon@irdes.fr
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Abstract

State Medical Aid is a public health insurance program that allows undocumented immigrants with low financial resources to access health care services for free. However, the low take-up rate of this program might threaten its efficiency. The purpose of this study is therefore to provide the determinants of such a low take-up rate. To this end, we rely on the Premier Pas survey. This is an original representative sample of undocumented immigrants attending places of assistance to vulnerable populations in France. Determinants of State Medical Aid take-up are analyzed through probit and Cox modeling. The results show that only 51% of those who are eligible for the State Medical Aid program are actually covered, and this proportion is higher among women than among men. The length of stay in France is the most important determinant of take-up. It is worth noting that State Medical Aid take-up is not associated with chronic diseases or functional limitations and is negatively associated with poor mental health. There is, therefore, mixed evidence of health selection into the program. Informational barriers and vulnerabilities experienced by undocumented immigrants are likely to explain this low take-up.

Keywords

Cox modelhealth insurance take-uphealth statusundocumented immigrants

JEL classification

I12: Health Behavior I14: Health and Inequality I28: Government Policy J15: Economics of Minorities, Races, Indigenous Peoples, and Immigrants • Non-labor Discrimination

Information

Type
Article
Information
Health Economics, Policy and Law , Volume 18 , Issue 1 , January 2023 , pp. 32 - 48
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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