ACCESS TO HEALTH-INSURANCE COVERAGE OF UNINSURED PATIENTS ATTENDING AN OUTPATIENT-CLINIC - A HISTORICAL PROSPECTIVE-STUDY IN PARIS, FRANCE

Background : In France health insurance coverage is universal (see not e at the end of the text), nevertheless some people remain uninsured. In this high-risk population, the lack of insurance coverage contribut es to the aggravation of health, by reducing access to medical care. I n 1992, the Baudelaire consultation was incorporated into the outpatie nt clinic of Saint-Antoine hospital (Paris, France), to provide the un insured with the same access as any other patient - but free of charge - to medical care. Social care was also provided in particular by ass isting the uninsured in applying for insurance coverage. Our objective s were to quantify the delay in obtaining insurance coverage and to st udy whether the sociodemographic characteristics of these patients wer e associated with inequalities in terms of delays. Methods :All patien ts attending the consultation for the first time in 1994 were included (n = 623). Because of differences linked to the French social securit y system, analysis was performed into two groups according to the exis tence of a prior insurance coverage. Delay in obtaining or recovering insurance coverage was considered as the key variable. The socio-demog raphic factors linked to the rates of access to insurance coverage wer e determined using Cox proportional hazards regression models. We also examined the factors linked with the existence of a prior insurance c overage by logistic regression modeling. Results : Within one year 96 % of the patients who had had insurance coverage in the past, and 63 % of the patients who had not, were insured. No factor whether national ity, educational level, socioprofessional category, family situation t ype of housing, mode of income was found to be linked with obtaining o r recovering insurance coverage. However, nearly all these factors wer e related with the existence of prior insurance coverage. Conclusions : Our approach of systematically providing social care allows 70 % of uninsured patients to obtain insurance coverage within one year. This approach probably contributes to an improvement by facilitating access to mainstream health care. Moreover, no difference in-delay in obtain ing insurance coverage was found associated with sociodemographic char acteristics.