The Minister of Health, Geneviève Darrieussecq, was in the hot seat last Tuesday, heard by the Social Affairs Committee on the appropriations for the Health mission of the second part of the finance bill for 2025. In a context of budgetary restriction, they amount to 1.64 billion euros, i.e. a reduction in payment credits of 40% compared to 2024. “This is not linked to a lesser ambition”, assures the minister who explains this reduction by that of payments from European programs to Social Security.
Three objectives are stated by the Health mission, the pursuit of policies in favor of prevention, access to care guaranteed to all in all territories, and the health security of all French people against epidemics.
Rapporteur for opinion, the Mahorese MP RN Anchya Bamana, split her report into two parts. The first on what would fuel the exchanges between the deputies, State Medical Aid (AME), the second on the persistent health inequalities in Mayotte.
Already threatened last year, the medical care of non-affiliated foreigners in France represented by the AME, was defended by the Minister of Health, who considers that it is “the best controlled public money of the Republic”. Its envelope increases by 9% to reach 1.2 billion euros in 2025, it represents more than half of the Health budget. Which made MP RN Anchya Bamana jump, “The number of AME beneficiaries reached 457,000 as of December 31, 2023, an increase of 11% between 2022 and 2023. This number has more than doubled in twenty years. » Who called for “reforming the AME” to reduce it “to the strict minimum”, that is to say transforming it into emergency medical aid, as advocated by his party but also by the LR like the minister of the Interior, Bruno Retailleau.
The absence of AME weighs on the Mayotte hospital
An LR MP supported this point of view during the debates in the Social Affairs Committee: “We cannot ask the French for efforts without the State rationalizing its spending”, by calling for control of illegal immigration. Facing her, a defender of the AME as it stands, “If we abolish the AME tomorrow, it will cost more in terms of public finances”, evoking late and more expensive support.
Remember that this aid allows foreigners to be taken care of by city medicine, making it possible to relieve congestion in hospital emergencies. Which makes it all the more incomprehensible that Mayotte is excluded, where the hospital center is suffering from congestion. We can no longer hear the risk of a draft, which cannot be worse than currently, as for the AME budget which could soar, data delivered by the Senate in 2023 should make us think: “64% of AME expenditure is concentrated on only ten CPAMs, 21% on the Paris CPAM, 10% on that of Bobigny and 8% on that of Cayenne. While the rate of immigrants is 30% in Guyana (INSEE).
Anchya Bamana, also a health executive at ARS Mayotte, was above all the rapporteur for opinions… on her department, taking advantage of the opportunity given to her to point out the degraded state of health. In fact, 70% of residents live in unsanitary housing, 25% of homes are not connected to drinking water, leading to a life expectancy lower than that of the mainland, 5 years less for men and 9 years for women in 2016, according to INSEE.
The 220% turnover of doctors increases EVASAN
The consequence of the absence of AME in Mayotte is a congestion of the hospital, particularly by foreigners in an irregular situation. As we have constantly repeated, treating the population of the region would imply releasing humanitarian funds to come to the aid of a hospital center that is running out of steam, one of two in France to receive a global envelope and not the activity, precisely because of its specificity. It was in deficit of 22 million euros in 2023, specifies the Mahorese MP.
Concentrating most of the care, it is increasingly deserted by health personnel, not only due to the insecurity which was rife, but also by the abolition of the Special Exercise Allowance (IPE) by the previous government. The loss of this bonus was fatal, leading to a turnover of 220% in 2023, further indicates Anchya Bamana.
This loss of skills has caused even more massive recourse to medical evacuations (EVASAN) to Reunion and mainland France, 1,800 patients in 2023, which further increases the health cost.
To the “shock of attractiveness” requested for Mayotte, the minister responded favorably, “I have signed a letter to authorize the renewal of the Special Exercise Allowance”, news which could stop the hemorrhage of departures, or even return at a certain level of attractiveness if insecurity continues to decline.
Generalization of PADHUE
As for attractiveness, “we are working on the remuneration of practitioners and their training in the department”, indicates Geneviève Darrieusecq. While Mayotte has benefited from a LAS, Health Access License, for two years, the establishment of a Specific Health Access Pathway (PASS) is requested by the Mayotte MP.
We contacted the Mayotte rectorate to take stock of this subject. Currently, thanks to LAS, places are reserved in the 2nd year of medicine for students from Mayotte. “We are working with the ARS and the hospital on a PASS, but we must first ensure the supervisory capacity.”
The subject of PADHUE doctors (Practitioner with a Diploma outside the European Union) in Mayotte, who obtained their diploma outside the EU and who practice in France, was also brought up again. It is the firmness that responded to the concerns of the medical world, the minister being in favor: “Their exercise must be facilitated in Mayotte as in mainland France, positions have been opened by the ARS”. As an observation of failure of the training of doctors in France.
The debate will take another direction in the Senate. The arguments for and against maintaining the AME in its current form will be heard there, with a majority right, which could rework the text by reducing the scope of the AME. Amendments have already been adopted to this effect.
Anne Perzo-Lafond
