Healthcare Reforms and the Creation of Ex‐/Included Categories of Patients — “Irregular Migrants” and the “Undesirable” in the French Healthcare System
| Author | Jérémy Geeraert |
| DOI | http://doi.org/10.1111/imig.12405 |
| Date | 01 April 2018 |
| Published date | 01 April 2018 |
Healthcare Reforms and the Creation of Ex-/
Included Categories of Patients —“Irregular
Migrants”and the “Undesirable”in the
French Healthcare System
J
er
emy Geeraert*
ABSTRACT
This article reconstructs the socio-historical processes that have led to the formal inclusion and
marginalization of “irregular migrants”in the French public health insurance system and the par-
allel legal production of exclusion of a share of this group. It interrogates the binary inclusion/
exclusion in the field of healthcare linking it to the logic of sovereignty and governmentality in a
stratified society. It shows how these processes have led to unequal health practices and
increased obstacles to accessing health insurance and healthcare providers, and, consequently,
has resulted in the exclusion of a share of this group from the regular healthcare system. These
two levels of discrimination are illustrated using empirical research on departments in French
public hospitals that have been designed to enable access to care for individuals without insur-
ance (Permanence d’acces aux soins de sante, or PASS: health care access units).
INTRODUCTION
The movements of workers from the “Third World”to the ”First World”after the Second World
War were followed by a stop in the active recruitment of new immigrants and restrictive immigra-
tion policies in the 1970s. As a result, the growing number of “irregular migrants”became a major
problem for Western nation-states.
Recent studies within the social sciences have shed light on the legal production of migrant “ille-
gality”by state policies (De Genova, 2002; Cvajner and Sciortino 2010; Calavita 2005; Coutin,
1996, 2000; Bloch and Chimienti, 2013), stressing the historicity of this phenomenon and empha-
sizing the need for historical accounts on the sociopolitical production of “illegalization”.
Processes of migrant “illegalization”are not limited to questions of residency and work permits.
In the case of France, the legal production of exclusion and illegality occurs within the healthcare
and health insurance systems as well (Izambert, 2010; Carde, 2009). An analogy between the pro-
duction of illegality regarding residency and the production of the exclusion of irregular migrants
from the healthcare system also indicates that “health”is a component of “citizenship”in modern
nation-states and stresses its biopolitic dimension (Ticktin, 2011; Fassin, 2001; Geeraert, 2017).
Furthermore, studies on healthcare access for irregular migrants have illuminated the production
of inequalities and discrimination in –and ultimately of exclusion from –the healthcare system in
France (Gabarro, 2012a, 2012b; Larchanch
e, 2012; Carde, 2006), revealing the binary inclusion/ex-
clusion logic that forms its foundation. This can be observed particularly in public hospitals’
* IRIS, Paris
doi: 10.1111/imig.12405
©2017 The Author
International Migration ©2017 IOM
International Migration Vol. 56 (2) 2018
ISS N 00 20- 7985 Published by John Wiley & Sons Ltd.
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