:: Health Legislation - Access to Health for Roma/ migrants

Health services are difficult to access for slum and squats dwellers because they are not reached by health actions “outside the walls” and because the places of life are generally far from health facilities.

Access to professional interpreting is an essential element for people to access quality care. However, health services rarely make use of this service for slum dwellers: in 2015, only 20 of the 205 health facilities that were partners of the mediation program used it. The lack of understanding of the discourse of the health professional leads to dissatisfaction of the professional himself,  disengagement of the patient in relation to his own health and possible errors in medical follow-up.

Most slum dwellers accompanied by the mediators of the program are eligible for the AME (Aide Médicale de l’Etat - Medical aid from the State) or for a minority for the CMU (Couverture Maladie Universelle – universal health coverage). The main issue in accessing health insurance is obtaining an administrative address. However, few municipalities comply with the law requiring them to domicile the people living on their territory. This has the direct consequence of limiting the access to health services for people who are living in remote areas and who are not sufficiently mobile to go in an institution, sometimes more than an hour away of their place of life.

On the other hand, while approximately 60% of the people supported by the mediators of the program were covered by health insurance in 2015, the associations noted difficulties to ensure access to health insurance for the other ones: duration of processing by the CPAM (Caisses Primaires d'Assurance Maladie – primary health insurance funds) goes beyond the timeframe provided by the law and is impeded by administrative barriers or requests for additional documents.

Access to primary health and general practitioners is also an important element of analysis. In France, the general practitioner (GP) ensures the first access to care and care coordination and the service is accessible to the beneficiaries of the AME. However, this remains very partial and still under-developed in certain territories. Refusal of care was also observed by the mediators of the Programme: 13 refusals of care were reported in 2015.



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