L’attribution de l’aide médicale d’Etat (AME) par les agents de l’Assurance maladie : entre soupçon de fraude, figures de l’étranger et injonctions gestionnaires

Abstract : In this dissertation, we address the issue of healthcare access for undocumented immigrants through the study of State Medical Aid (referred to as AME – Aide Médicale d’Etat) – a healthcare coverage specifically dedicated to them. Based on an ethnographic study carried out on both sides of the counter at Health Insurance Offices (referred to as CPAM - caisses primaires d’Assurance maladie), we question the impact of an increasingly managerial approach to healthcare and of CPAM occupational mutations on AME attribution. We show how a rhetoric of suspicion developed in this administration, towards foreigners in particular. Event though this rhetoric is institutionalized, we shall see how it can also be individually reappropriated, in a context where the meaning of labor is strongly called into question, and where professional identities are undermined. While all agents share a common discourse on the fight against social fraud, they nevertheless use this logic in different ways. As a result, agents may distinctively promote a managerial expertise, a social expertise, or a system gatekeeper expertise. Finally, this dissertation shows how the use of a suspicion rhetoric does not necessarily produce a rigorist reading of AME, even if the latter dominates. On the contrary, it may also call on a social or managerial perspective – given the specificity of AME and its separate processing – that may facilitate healthcare access for undocumented immigrants.
Keywords : Fraud suspicion
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Céline Gabarro. L’attribution de l’aide médicale d’Etat (AME) par les agents de l’Assurance maladie : entre soupçon de fraude, figures de l’étranger et injonctions gestionnaires. Sociologie. Université Sorbonne Paris Cité, 2017. Français. ⟨NNT : 2017USPCC167⟩. ⟨tel-02079419⟩

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