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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
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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References

Aizer, A (2003) Low take-up in Medicaid: does outreach matter and for whom? The American Economic Review 93, 238–241.Google Scholar
Aizer, A (2007) Public health insurance, program take-up, and child health. The Review of Economics and Statistics 89, 400–415.CrossRefGoogle Scholar
Allen, H, Baicker, K, Finkelstein, A, Taubman, S, Wright, BJ and Oregon Health Study Group (2010) What the Oregon health study can tell us about expanding Medicaid. Health Affairs 29, 1498–1506.Google Scholar
Andersen, R and Newman, J (1973) Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly. Health and Society 51, 95–124. doi: 10.2307/3349613Google ScholarPubMed
Baicker, K, Congdon, WJ and Mullainathan, S (2012) Health insurance coverage and take-up: lessons from behavioral economics. The Milbank Quarterly 90, 107–134.CrossRefGoogle ScholarPubMed
Bertrand, M, Luttmer, EF and Mullainathan, S (2000) Network effects and welfare cultures. The Quarterly Journal of Economics 115, 1019–1055.Google Scholar
Bhargava, S and Manoli, D (2015) Psychological frictions and the incomplete take-up of social benefits: evidence from an IRS field experiment. The American Economic Review 105, 3489–3529.CrossRefGoogle Scholar
Bitler, MP and Zavodny, M (2014) Medicaid: a review of the literature. NBER Working Paper No. w20169.Google Scholar
Brousse, C (2006) Le réseau d'aide aux sans-domicile: un univers segmenté. Économie et statistique 391, 15–34.Google Scholar
Brousse, C, de la Rochère, B and Massé, E (2002) Hébergement et distribution de repas chauds. Le cas des sans-domicile. Insee première, no. 823.Google Scholar
Chernew, M, Frick, K and McLaughlin, CG (1997) The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage? Health Services Research 32, 453–470.Google ScholarPubMed
Collins, SR, Gunja, MZ, Doty, MM and Beutel, S (2016) ‘Who are the remaining uninsured and why haven't they signed up for coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey’, February–April 2016 [Internet]. New York (NY): Commonwealth Fund; 2016 Apr [Internet].Google Scholar
Combes, SJ-B, Simonnot, N, Azzedine, F, Aznague, A and Chauvin, P (2019) Self-perceived health among migrants seen in Médecins du Monde free clinics in Europe: impact of length of stay and wealth of country of origin on migrants’ health. International Journal of Environmental Research and Public Health 16, 4878.Google ScholarPubMed
Craig (1991) Costs and benefits: a review of research on take-up of income-related benefits. Journal of Social Policy 20, 537–565.CrossRefGoogle Scholar
Currie, J (2006) The take up of social benefits. In Auerbach, AJ, Card, D and Quigley, JM (eds), Public Policy and the Income Distribution. New York: Russel Sage, pp. 80–148.Google Scholar
Desprès, C, Guillaume, S and Couralet, PE (2009) Le refus de soins à l'égard des bénéficiaires de la Couverture maladie universelle complémentaire à Paris. Fonds de financement de la protection complémentaire de la couverture universelle du risque maladie, La documentation française, collection des rapports publics.Google Scholar
Dourgnon, P, Guillaume, S, Jusot, F and Wittwer, J (2019) « Etudier l'accès à l'Aide Médicale de l'Etat des personnes sans titre de séjour ». Irdes, Questions d'économie de la santé, n°244, novembreGoogle Scholar
European Union Agency for Fundamental Rights (FRA) (2015) ‘Cost of exclusion from healthcare – the case of migrants in an irregular situation’, report.Google Scholar
Finkelstein, A, Hendren, N and Shepard, M (2019) Subsidizing health insurance for low-income adults: evidence from Massachusetts. American Economic Review 109, 1530–1567.CrossRefGoogle ScholarPubMed
Fonds CMU-C (2019) 2018 Activity Report.Google Scholar
Gabarro, C (2012) Les demandeurs de l'aide médicale d’État pris entre productivisme et gestion spécifique. Revue européenne des migrations internationales 28, 35–56.CrossRefGoogle Scholar
Gabarro, C (2017) L'attribution de l'aide médicale d'Etat (AME) par les agents de l'Assurance maladie. Entre soupçon de fraude, figures de l’étranger et injonctions gestionnaires. Sorbonne Paris Cité.Google Scholar
Gosselin, A, Melchior, M, Carillon, S, Gubert, F, Ridde, V, Kohou, V, Zoumenou, I, J-N, Senne and AD, du Loû (2021) Social and mental health risks faced by undocumented migrants during the COVID-19 pandemic: evidence from three surveys in France. medRxiv.Google Scholar
Guthmuller, S, Jusot, F, Renaud, T and Wittwer, J (2014a) Comment expliquer le non-recours à l'Aide à l'acquisition d'une complémentaire santé? Les résultats d'une enquête auprès de bénéficiaires potentiels à Lille en 2009. Regards 2, 59–74.Google Scholar
Guthmuller, S, Jusot, F and Wittwer, J (2014b) Improving takeup of health insurance program a social experiment in France. Journal of Human resources 49, 167–194.Google Scholar
Hahn, Y (2013) The effect of Medicaid physician fees on take-up of public health insurance among children in poverty. Journal of Health Economics 32, 452–462.Google ScholarPubMed
Handel, BR, Kolstad, JT and Spinnewijn, J (2019) Information frictions and adverse selection: policy interventions in health insurance markets. Review of Economics and Statistics 101, 326–340.Google Scholar
Hoffart, J (2018) ‘The Oregon health insurance experiment: analyzing government-provided health insurance take-up across demographic variables’, thesis presented to the Department of Economics and the Robert D. Clark Honors College in partial fulfillment of the requirements for the degree of Bachelor of Science June 2018.Google Scholar
Ichou, M and Wallace, M (2019) The healthy immigrant effect: the role of educational selectivity in the good health of migrants. Demographic Research 40, 61–94.Google Scholar
Jusot, F, Dourgnon, P, Wittwer, J and Sarhiri, J (2019) « Le recours à l'Aide médicale de l'Etat des personnes en situation irrégulière en France : premiers enseignements de l'enquête Premiers pas ». Irdes, Questions d'économie de la santé, n° 245, novembre.Google Scholar
Kroenke, K, Spitzer, RL and Williams, JB (2001) The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.Google ScholarPubMed
Liou, W (2018) Word to the mother(tongue): language access and Medicaid for limited English proficient migrants. IZA Journal of Development and Migration 8, 1–17. https://doi.org/10.1186/s40176-018-0130-xGoogle Scholar
Margerison, CE, MacCallum, CL, Chen, J, Zamani-Hank, Y and Kaestner, R (2020) Impacts of Medicaid expansion on health among women of reproductive age. American Journal of Preventive Medicine 58, 1–11.CrossRefGoogle ScholarPubMed
Marsaudon, A, Dourgnon, P, Jusot, F and Wittwer, J (2020) « Anticiper les conséquences de l'épidémie de la Covid-19 et des politiques de confinement pour les personnes sans titre de séjour ». Irdes, Questions d'économie de la santé, n°253, décembre.Google Scholar
Moffitt, R (1983) An economic model of welfare stigma. The American Economic Review 73, 1023–1035.Google Scholar
Mordier, B (2016) Introduction de cadrage. Les sans-domicile en France: caractéristiques et principales évolutions entre 2001 et 2012. Economie et Statistique 488, 25–35.Google Scholar
Nandi, A, Galea, S, Lopez, G, Nandi, V, Strongarone, S and Ompad, DC (2008) Access to and use of health services among undocumented Mexican immigrants in a US urban area. American Journal of Public Health 98, 2011–2020.CrossRefGoogle Scholar
Odenore (2012) L'envers de la ‘Fraude Sociale’. Scandale du non Recours aux Droits Sociaux. Paris: Collection Repères-la Découverte.Google Scholar
Remler, DK and Glied, SA (2003) What other programs can teach us: increasing participation in health insurance programs. American Journal of Public Health 93, 67–74.Google ScholarPubMed
Stuber, J and Bradley, E (2005) Barriers to Medicaid enrollment: who is at risk? American Journal of Public Health 95, 292–298.Google ScholarPubMed
Van Mechelen, N and Van Der Heyden, M (2017) La lutte contre le non-take-up: un inventaire des mesures de politiques et réflexion à la lumière de la littérature scientifique et des expériences de politique au Royaume-Uni et en Suède.Google Scholar
Vargas, ED (2015) Immigration enforcement and mixed-status families: the effects of risk of deportation on Medicaid use. Children and Youth Services Review 57, 83–89.Google ScholarPubMed
Vargas, ED, Sanchez, GR and Juárez, M (2017) Fear by association: perceptions of anti-immigrant policy and health outcomes. Journal of Health Politics, Policy and Law 42, 459–483.CrossRefGoogle ScholarPubMed
Vignier, N, Desgrées du Loû, A, Pannetier, J, Ravalihasy, A, Gosselin, A, Lert, F, et al. (2018) Access to health insurance coverage among sub- Saharan African migrants living in France: results of the ANRS-PARCOURS study. PLoS ONE 13, e0192916. https://doi.org/10.1371/journal.pone.0192916.CrossRefGoogle ScholarPubMed
Watson, T (2014) Inside the refrigerator: immigration enforcement and chilling effects in Medicaid participation. American Economic Journal: Economic Policy 6, 313–338.Google Scholar
Wright, BJ, Garcia-Alexander, G, Weller, MA and Baicker, K (2017) Low-cost behavioral nudges increase Medicaid take-up among eligible residents of Oregon. Health Affairs 36, 838–845.Google ScholarPubMed
Wittwer, J, Raynaud, D, Dourgnon, P and Jusot, F (2019) « Protéger la santé des personnes en situation irrégulière en France. L'Aide médicale de l'Etat, une politique d'accès aux soins mal connue ». Irdes, Questions d'économie n° 243, novembre.Google Scholar