On November 28, 2023 during the discussion of the bill “to control immigration, improve integration”, the law committee of the National Assembly notably adopted articles 1 E and 1 F, voted by the Senate and which modify access to the residence permit for care issued to sick foreigners. These articles aim to drastically restrict the possibilities of obtaining a temporary residence permit for sick foreigners, usually residing in France and requiring medical care, the failure of which could have exceptionally serious consequences for them. It is useful to remember that the number of residence permits for care is low and has decreased drastically since 2016. This concerned less than 4,000 (less than 2%) new residence permits each year (source: MI – DSED – January 26 2023). They mainly benefit people living with HIV/AIDS, hepatitis, tuberculosis, severe psychiatric illness, insulin-requiring diabetes, cancer or even severe kidney failure.
Current legislation provides that “a foreigner, habitually residing in France, whose state of health requires medical care whose defect could have exceptionally serious consequences for him and who, having regard to the offer of care and the characteristics of the health system in the country from which he or she comes, could not actually benefit from appropriate treatment, is issued a temporary residence card bearing the mention ‘private and family life’ for a duration one year”. The immigration bill proposes to modify the restrictive clause above with the following wording: “subject to the absence of appropriate treatment in the country of origin and that this support is not borne by the “health insurance” and “The consequences of exceptional gravity, within the meaning of the first paragraph of this article, are assessed taking into account the risk that the lack of medical care poses to the vital prognosis of the foreigner or the “significant alteration of one of its important functions, but also of the probability and presumed time of occurrence of these consequences.”
The effectiveness of a treatment does not only depend on the presence on the market of a drug. The effective availability of medicines, their accessibility, the regularity of their distribution and their sustainability constitute essential factors to guarantee the effectiveness of prescribed treatments and also prevent the emergence of multi-resistant infections. Restricting the consequences of exceptional severity to serious short-term pathologies also goes completely against the prevention of complications of severe pathologies in the absence of monitoring. This is the case, for example, for long-term complications of diabetes or heart failure. The same applies in the event of lack of follow-up for a severe psychiatric pathology, for renal failure or even for HIV infection or tuberculosis.
As health professionals, we consider that the restrictive redefinition of the conditions for obtaining a residence permit for seriously ill foreigners, usually residing in France, constitutes a regression, with serious consequences for patients. , for public health and for state finances.
Ethical, health and financial reasons
Ethically questionable, Articles 1 E and 1 F will above all contribute to degrading access to care for the most precarious, to increasing the risks of exposure and contamination of the population to serious or contagious pathologies, and, ultimately, to increase the operating costs of hospitals. The new legislation, if adopted, will have the consequence of rejecting the irregularity of the stay of a number of patients and in turn lead to the loss of their employment, their housing and their possible disability compensation benefits. Their recourse to care will therefore be later and their retention in care less regular. These patients will therefore present with more advanced pathologies, requiring heavier and more expensive treatments. In fact, the tightening of legislation would mainly have the accounting effect of transferring the care of these sick people to State medical aid and the budgets of hospital services.
For these three reasons (ethical, health and financial), the adoption of articles 1 E and 1 F of the bill “control immigration, improve integration” will have harmful consequences. We therefore ask you to reject these articles, to reverse the restrictions that have been added to it and to guarantee the sustainability of a system whose health effects benefit the entire population in France.
*The signatory learned societies: French-speaking infectious pathology society (SPILF); French Society for the Fight against AIDS (SFLS); French Society of Endocrinology (SFE); French Cancer Society (SFC); French Society of French-speaking Pneumology (SPLF); French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT); French Public Health Society (SFSP); National coordination of PASS; French Federation of Diabetics (FFD).
First signatories: Dr Nathalie De Castro, infectious disease specialist, Paris; Mathieu Lafaurie, infectious disease specialist, Paris; Professor Nicolas Vignier, infectious disease specialist, Bobigny; Dr Hugues Cordel, president of the French Society for the Fight against AIDS; Dr Bernard Castan, president of the French-language Society of Infectious Pathology; Professor François Vrtovsnik, president of the French-speaking Society of Nephrology, Dialysis and Transplantation; Professor Anne Barlier, president of the French Society of Endocrinology; Professor Manuel Rodrigues, president of the French Cancer Society; Professor Anne Vuilllemin, president of the French Society of Public Health; Professor Françoise Barré Sinoussi, 2008 Nobel Prize in Medicine, president of Sidaction. And more than 1,300 caregivers signatories