Health Care Reform and Creation of an Excluded Category of Patients

Friday, July 18, 2014: 4:40 PM
Room: 501
Distributed Paper
Jérémy GEERAERT , École Hautes Études Sciences Sociales, Bobigny, France
The will to universalize the French health insurance system at the end of the 90's created a new marginalized category of patients: illegal migrants.
Splitting them from the other insurance holders by the establishment of a special health insurance (Aide Médicale d'État, State Medical Aid), this population was put at the edge of the health system. It led to unequal health practices and increased the difficulties to access health care providers and health insurance.
These two levels of barriers have been underlined by the empirical research based on the study of a department in the French public hospital, named PASS (Permanence d’accès aux soins de santé : Department of health care access). The PASS is specialized in taking care of patients without health care insurance which are mainly illegal migrants.
Separating the Aide Médicale d'État from the other insurances made possible for the administration and practitioners to have discriminating practices. The administration uses the processing of the applications (delaying them for example), while some practitioners exclude those patients from their practice. These barriers keep a part of this population out of the regular health care system, compelling them to go to special health care providers as the PASS. However, the specialization of health practitioners in those patients generated new practices, which showed the relevance and the complementarity of combined social and medical care, networking, and recognition of the social and cultural determinants of health.
This paper is based on an ongoing Ph.D empirical study in sociology about the treatment of the social question in and by public hospitals in France through the analysis of the PASS.