PREMIERS-PAS

The « Premiers Pas » (First-Steps) project addresses Undocumented Immigrants’ trajectories in terms of access to healthcare and to health insurance, from longitudinal and multidisciplinary perspectives. It aims at answering the following questions: - To what extent do undocumented immigrants (referred to as “UI” below) actually access healthcare and health insurance in France? In particular, what factors can explain the use or non-take up of the state funded health insurance for UI (“Aide Médicale d’Etat”, or AME), access to public healthcare providers, private practices, NGO facilities, and alternative treatment? - What are the dynamics of undocumented immigrants trajectories regarding AME, means tested public health cover (“Couverture Maladie Universelle: CMU” and “Couverture Maladie Universelle Complémentaire: CMUC”) Public Insurance, non-insurance, and related health care consumptions? The project is divided into two Work Packages (WP1 and WP2), designed so as to complement each other. WP1 aims to follow immigrants’ healthcare and insurance pathways, as well as ways of self-appropriation of the AME insurance, over a one year and a half period. It will build on socio-anthropological and economic approaches, including qualitative approaches and a multimode survey. WP2 aims to assess the feasibility of a panel of individuals insured to AME, from administrative data, and propose first cross sectional results. Beyond the expected academic outcomes, the project, conducted in a collaboration with Médecins du Monde (MdM), has been designed to be directly productive to policymakers and field workers in the health and social sectors, whether public or associative. The WP1 qualitative study aims to analyze healthcare trajectories of adult AME beneficiaries. It will describe UI’s perceptions of the AME and account for UI concrete experience of healthcare use in France. It will address the representations and practices of UI, health professionals, social services workers, and stakeholders. This study includes a socio-anthropological study and a medical survey. The quantitative study aims to construct typologies of UI’s trajectories, in terms of health status, insurance, and healthcare consumption. These typologies will be described according to UI’s social and family situations and migratory trajectories and personal history. The survey will be conducted in Aquitaine and Ile de France regions. Participants will be enrolled among public health service users (PASS and CPAM especially), in Médecins du Monde healthcare facilities, medical practices, and possibly non-medical facilities. We will test and possibly implement “snowball” or “respondent driven” sampling methods to reach non-taker immigrants through other participants. The WP2 panel shall, over time, monitor a sample of AME recipients, i.e. follow the sequence of their entitlements, on the basis of their national identification number. AME insurance is granted for one year, then renewable; it can also switch to registration to basic CMU or a compulsory scheme or, simply, not be renewed if the insured have waived going through the process again, or have left the country. We will seek to collect information on the use of health services from administrative claims. This will include ambulatory care (Source: Health insurance DCIR) and hospital care (Source: PMSI), including the use of hospital emergency departments and care provided in psychiatric facilities (Source: Rim-P).