GUTHMULLER Sophie

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The Aide à l'acquisition d'une complémentaire santé (ACS) is a scheme, in the form of financial assistance, set up in 2005 to promote access to health care for people with incomes just above the ceiling for eligibility for the Couverture maladie universelle complémentaire (CMU-C). Despite its increase in coverage, non-use of the ACS is significant, with only 22% of eligible individuals having claimed their right in 2011 (Fonds CMU, 2012). In this context, understanding the reasons for non-take-up seems essential to improve the effectiveness of the system and enable people on low incomes to access complementary health insurance. Following a social experiment, a survey was carried out in 2009 in Lille among people potentially eligible for the ACS in order to better understand their characteristics and their motivations or obstacles to using the system. The results of this survey show that the population identified as eligible for the ACS in Lille is faced with economic and social difficulties and has significant healthcare needs. However, the ACS take-up rate is low, with only 18% of people having taken steps to obtain it. The reasons most often given for not taking up the ACS are: the belief that they are not eligible, lack of information, the complexity of the procedures and, for those not covered, the price of the complementary health insurance, even after deducting the health check.

The purpose of this research is to study the financial access to complementary health care and to health care for low-income populations in France. We are particularly interested in the Aide complémentaire santé (ACS) scheme, which was introduced to encourage households whose resources are just above the ceiling of the Couverture maladie universelle (CMUC) to acquire complementary health insurance. Based on a social experiment and a new sample of households eligible for these schemes, we are able to shed light on three questions: (i) Understanding and reducing non-use of the ACS. (ii) Behaviour in the use of complementary health insurance and care. (iii) The existence of a threshold effect of the CMUC. The results of this thesis will be used to improve the effectiveness of these schemes and, more generally, of future public policies aimed at improving equity in access to care.