Hospital admissions for undocumented immigrants: a comparative analysis of French healthcare coverage schemes

Disparities in healthcare access persist in European countries for undocumented immigrants and are influenced by political issues. In France, healthcare access for this population is divided between two programs: the State Medical Aid (SMA), which provides broad healthcare coverage, and the Urgent and Vital Care (UVC) program, which is limited to life-threatening conditions for those ineligible for SMA or other assistance. Analyzing hospital admissions and costs related to these programs can provide insights into the implications of restricted healthcare access. This retrospective cohort study used data from the French national hospitalization database between 2013 and 2021. All hospital stays involving undocumented immigrants covered under either the SMA or UVC programs were included. The primary outcome was the average cost per hospital stay for each program. Secondary outcomes included length of stay (LOS) and use of intensive care unit (ICU). Multivariable generalized linear mixed models were employed to adjust for patient and hospitalization characteristics. The study included 197 327 patients under SMA and 40 322 under UVC. Emergency department admissions accounted for 47% of SMA hospitalizations compared to 68% for UVC. The average cost per SMA stay was €3758 (95% CI, €3637-€3883), which was 13% lower than UVC stays (average absolute difference, AAD: €504). UVC patients had a 16% higher probability of ICU admission (AAD: 1.08 days in ICU) and a 19% higher total LOS compared to SMA patients. Undocumented immigrants without comprehensive healthcare coverage under SMA incur higher hospital costs, longer stays, and increased ICU admission rates than those covered by SMA.