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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

Dourgnon, Paul; Jusot, Florence; Marsaudon, Antoine; Sarhiri, Jawar; Wittwer, Jérôme (2023), Just a question of time? Explaining non-take-up of a public health insurance program designed for undocumented immigrants living in France, Health Economics, Policy and Law, 18, 1, p. 32-48. 10.1017/S1744133122000159

Type
Article accepté pour publication ou publié
Date
2023
Journal name
Health Economics, Policy and Law
Volume
18
Number
1
Publisher
Cambridge University Press
Pages
32-48
Publication identifier
10.1017/S1744133122000159
Metadata
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Author(s)
Dourgnon, Paul
Institut de Recherche et Documentation en Economie de la Santé [IRDES]
Laboratoire d'Economie de Dauphine [LEDa]
Jusot, Florence
Laboratoire d'Economie et de Gestion des Organisations de Santé [Legos]
Institut de Recherche et Documentation en Economie de la Santé [IRDES]
Laboratoire d'Economie de Dauphine [LEDa]
Marsaudon, Antoine
Institut de Recherche et Documentation en Economie de la Santé [IRDES]
Paris Jourdan Sciences Economiques [PJSE]
Sarhiri, Jawar
Wittwer, Jérôme
Institut de Santé Publique, d'Epidémiologie et de Développement [ISPED]
Laboratoire d'Economie et de Gestion des Organisations de Santé [Legos]
Bordeaux population health [BPH]
Laboratoire d'Economie de Dauphine [LEDa]
Abstract (EN)
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.
Subjects / Keywords
Cox model; health insurance take-up; health status; undocumented immigrants
JEL
I12 - Health Behavior
I14 - Health and Inequality
I28 - Government Policy
J15 - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination

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