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L’assistance d’État gérée par l’assurance maladie (CMU/AME)

Abstract : Implementation of Universal Health Coverage (CMU) / State Medical Aid (AME) in 2000 is part of a historic tension between assistance and insurance. Far from finalizing the process of universalizing social protection, the CMU / AME constitutes a state assistance mechanism. The increase in the cost of the latter, observed and studied in a primary health insurance fund from 2004 to 2008, is embedded in a new managerial organization of physical reception which governs the classification and downgrading of users and agents. This State assistance system, linked to the reconfiguration of reception, generates, among reception agents, uses of discretionary power - ranging from benevolence to punishment - in their interrelations at the counter with the most frequent users precarious. The exercise of discretionary power originates in the new governance of health insurance which calls for the managerial rationalization of physical reception, the "control of expenditure" and the "fight against fraud". In a configuration where health insurance has been invested with a state function, the "assisted" depends strongly on the moral judgment of the agent, who by the exercise of pastoral power (Foucault, 2004) makes the doubly dependent user.
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Preprints, Working Papers, ...
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Contributor : Vianney Schlegel <>
Submitted on : Saturday, April 24, 2021 - 1:07:56 PM
Last modification on : Monday, May 10, 2021 - 11:56:51 AM


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  • HAL Id : hal-03207277, version 1



Pascal Martin. L’assistance d’État gérée par l’assurance maladie (CMU/AME). 2021. ⟨hal-03207277⟩



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