Comparison of the Characteristics and Costs of Vulnerable Populations Hospital Stays in France Regarding Their Coverage Type Between 2011 and 2021

OBJECTIVES: France has three programmes to provide care for vulnerable populations: state medical aid (AME) for undocumented immigrants after 3-6 months of residency; urgent and vital care (SUV) for other undocumented immigrants, and state-sponsored complementary health insurance (CSS). The rest of French residents are covered by the compulsory health insurance (AMO). The aim of our study was to compare characteristics, resource use and costs of patients depending on coverage type.

METHODS: We used the national hospital database, which includes all hospitalizations in France from 2011 to 2021 in an exhaustive and anonymous manner. We extracted all stays of patients under AME and SUV, and took a random sample for patients covered by AMO and CSS. We performed descriptive analyses and regression models (gamma family GLM with a logarithmic relationship) explaining costs according to the coverage type and patient characteristics.

RESULTS: The average (standard deviation) age was 31.4 (18.9), 34.6 (18.4), 34.0 (23.6) and 48.0 (28.2) for patients receiving AME, SUV, CSS and AMO respectively. The proportion of obstetrics represented 19.5,21.1,8.1,8.3% of stays, respectively. Proportionally to population density, stays for AME and SUV were 7 and 26 times higher, respectively, in the overseas territories and Paris than in the rest of the country, whereas AMO and CSS stays were evenly distributed. Stays for patients receiving SUV more frequently included a stay in intensive care (6.9% vs. 4.5% for AME, 5.8% for CSS, and 4.6% for AMO), and cost on average €1396 (95% confidence interval: 1290-1460) more than other types of care.

CONCLUSIONS: The profile of vulnerable patients hospital stays and their costs was different according to their coverage type. After adjusting for the patients characteristics, the costs of hospital stays was still significantly different.