Health for
all
Couverture maladie universelle
(CMU - universal sickness
coverage): the creation of CMU by the Act of 27 July 1999 is a
major weapon in the fight against marginalization. Various surveys had
shown that access to health care was not equal; in 1998, for instance, one
out of seven people and 30% of the unemployed were unable to afford health
care as they could not pay their share of the costs. CMU, which came into
force on 1 January 2000, should ensure that health care is genuinely
available for everyone. It has two strands:
- membership of the basic social security scheme for all residents
in stable and regular circumstances who do not have entitlements under
sickness insurance. A "stable situation" is taken to mean that
the person has been a permanent resident of France for more than three
months. People who are homeless or in very insecure housing situations
may designate a local authority welfare center or an approved association1
as their abode;
- free supplementary
cover, covering medical costs not reimbursed by sickness insurance
schemes. Beneficiaries therefore have nothing to pay for consultations and
medical treatment. They can also opt for direct payment by insurers, i.e.
they do not have to pay for their health care and then wait for
reimbursement. Beneficiaries can choose, for the management of their
supplementary CMU, either their primary sickness insurance fund or an
approved body (mutual, insurance company, etc.). Eligibility for
supplementary cover is means-tested (EUR 533.57 per month for a single person). Estimates set the potential number of people eligible for CMU at
6 million. At the end of June 2000, six months after its introduction, 4.2
million people - i.e. nearly 70% of the population involved - were
benefiting from this scheme. Its success shows how much it was needed. In
addition to receiving adequate care if they fall ill, people are also
eligible for dental treatment and prescriptions for spectacles which they
previously tended to do without.
PRAPS and PASS:
the 1999 Act also provided for the introduction of PRAPS (programmes
régionaux pour l'accès à la prévention et aux soins - regional
programmes for access to preventive care and treatment). In each
department, a PRAPS is drawn up following a preliminary analysis of health
care provision for the most disadvantaged. It sets out coordinated
preventive and health education measures, specifies the part that the
various services and institutions will play in them and lays down measures
to combat illnesses aggravated by insecurity, vulnerability and
marginalization. Within these programmes, the PASS (permanences
d'accès aux soins de santé) are medical and welfare reception units
which help the most disadvantaged gain access to the hospital system. Each
PASS must include a reception system through which situations of distress
can be identified, medical consultations, welfare consultations and the
issue of a paper detailing their various hospital consultations and
entitling them to the medicines prescribed. It is run by a steering
committee including doctors, pharmacists, administrators, nursing managers
and social services: this committee is open to partner associations1
and social services. On 30 April 2000, 183 of these PASS had formed
steering committees and 138 had drawn up their medical, welfare and
administrative entitlement, reception and monitoring procedures.
Housing
Housing is a key factor in
integration. Obtaining a decent home with a rent that the family can
afford is the dream of the most disadvantaged. It is just as essential for
people to keep their homes, as they may descend into poverty and enter a
potentially irreversible state of marginalization if they are evicted and
forced onto the streets. It is for this reason that the fight against
marginalization includes a whole range of measures to improve access to
housing and prevent eviction:
Departmental housing access plans: these
are designed to boost and coordinate the action of the various services
and bodies concerned and are drawn up for a minimum of three years. A
committee responsible for the plan is chaired jointly by the Prefect (who
represents the State in each French department) and the Chairman of the
General Council (the department's elected decision-making organ). Inter
alia, the committee assesses the effects of the plan so that any
adaptations which may become necessary can be made. The plan also lays
down the eligibility criteria for the FSL:
-
the
FSLs (fonds de solidarité logement - housing solidarity
funds) are intended to help disadvantaged people with rent
arrears to keep their homes or find new ones. These funds offer loans,
grants and guarantees and finance welfare support measures. On 30
June 2000, the FSLs had assisted 1,500,000 households.
Better allocation of local authority
housing: several schemes are
involved here:
- departmental
collective agreements: in each French department, the Prefect enters
into a three-year collective agreement with local authority housing
services, specifying the number of dwellings that the latter undertake
to allocate each year and a waiting-time beyond which applications must
be examined on a priority basis;
- intercommunal
housing conferences: bringing together the department's
communes which have sensitive urban areas or a large number of local
authority social housing units, these give an opinion on the draft
departmental collective agreement and draw up an intercommunal charter
setting out the obligations that each commune and each local authority
must respect under the plan;
- single departmental
registration: any application for local authority housing now has to
be registered and a number allocated. The fact that all applications now
have to be registered and that housing cannot be allocated without a
number being issued means that allocation is more transparent and
applicants are on a more equal footing. It is also possible to measure
applicants’ waiting-times, and calculate the number of housing
applications and categorize them better.
Fighting eviction: A preventive approach should enable action
to be taken well before the dramatic and traumatizing stage of eviction
is reached. In the case of social housing, the local authority section
managing the property must, before initiating court proceedings to recover
rent arrears, take the case to the departmental housing benefit section
or the family benefits fund to find ways of settling these rent arrears.
The local authority managing the property can initiate case proceedings
(summons) only three months after the case has been taken to the competent
body. Regardless of whether the property belongs to a private landlord
or the local authority, two months must have elapsed from the summons
before the courts can give a ruling. The bailiff responsible for informing
the tenant of his court summons must also notify the Prefect who is responsible
for expediting a welfare investigation with the competent bodies. Eviction
prevention charters must also be drawn up in all departments. The Act
also states that "any person or family experiencing particular hardship
because of their insecurity and vulnerability is entitled to local authority
assistance to gain or retain access to water and energy supplies and a
telephone service". National agreements are drawn up for this purpose
between the State and Electricité de France, Gaz de France and the water
companies, setting out the amount and the methods of their respective
contributions. In each department, agreements are drawn up between the
local representatives of water and energy companies and local authorities
or, where appropriate, welfare organizations in order to decide how the
national agreements are to be applied.
Guaranteeing
a minimum income
Better procedures for management
of excessive debts: legal steps have been taken to improve the
management of cases where households are facing hardship because of
excessive debts resulting from a loss of income due to unemployment,
health problems or the death of a spouse, all of which are events that
lead to what is termed passive debt, in contrast to active debt which is
the result of excessive use of credit.
- the composition of the
debt commissions has been improved so that account can be taken
of all aspects of the debtor’s financial situation. The inclusion of a
representative of the departmental Director of Taxation Services means
that debts to the State and local authorities and State-owned utilities
can be dealt with in a coordinated way;
- debtors can
be heard by the commission and are thus able to give a more personal
account of their circumstances than is possible in an administrative file.
A procedure for determining liabilities allows debtors who contest certain
debts to get them checked.
- debt repayments
may be spread over eight years. For the most financially disadvantaged, a
moratorium of up to three years is possible. At the end of the moratorium,
the commission may, in cases of extreme hardship, cancel all or some of
the debts;
- the repayment plan
must leave the person and their family with an income enabling them to
cope with the expenses of daily life. A single person’s income cannot be
lower than the RMI (or minimum income guaranteed to all individuals over
the age of 25 whose income from all sources is below a certain level -
currently some EUR 389.05 for a single person).
The right to a bank account: the law states that anyone is entitled
to open a bank account. People whose applications to open accounts are refused
may take their case to the Bank of France which will help them open an account.
Approximately 6,000 people used this procedure in 1999.
Better
opportunities for culture, education and leisure
The fight against
illiteracy: illiteracy, i.e. the inability to read a simple everyday text,
is a major handicap causing problems in working life as well as in the
most ordinary social relationships. In the reading tests carried out
during the days of introduction to military service (attendance has been
compulsory for all French young people since the end of conscription), an
average of 5% of young people found it very difficult to read a text. This
is why the law states that "the fight against illiteracy is a
national priority. All the public services shall contribute in a
coordinated way to the fight against illiteracy in their respective fields
of action". It has been decided to set up a public interest grouping
which will be responsible for spearheading, coordinating and assessing
policy to combat illiteracy. The choice of this status is explained by the
need to bring public and private law bodies under the same umbrella:
Ministries, State-supervised bodies, regions, industry sector
representatives, etc.
Promoting children’s education: the
Ministry of Education has introduced schemes to try to prevent young
people from being excluded from school or suffering social marginalization:
young people who have failed at school and whose behaviour has started to
become disruptive can be kept within or re-integrated into the education
system through the classes relais and internats relais (special
classes and schools for children with problems). Collège grants (collèges
cater for pupils aged approximately 11-15 years) were also re-introduced
at the beginning of the 1998-1999 academic year for the least advantaged
families.
Merit grants, created at
the beginning of the 2000-2001 academic year, should help 10,000 holders
of collège grants who have obtained good results in their brevet
des collèges (certificate of general education) to continue their
education to baccalauréat level. These supplement lycée
(15-19 years approximately) grants and offer pupils a chance to take
advantage of cultural, social and occupational opportunities from which
students from better-off families can already benefit as a result of their
environment.
Opportunities for
leisure and sport: this is an
important aspect as, in the view of disadvantaged families themselves, the
fact that they never go on holiday and can never offer their children the
opportunity to play their favourite sport, brands them socially and makes
them feel that they are different from everyone else and excluded from a
major part of social life. The initiatives which have been introduced
therefore include:
- the bourse
solidarité vacances (holiday solidarity grant): this a
public interest grouping set up by the Minister of State for Tourism
bringing together private-sector tourism companies, associations1
organizing holidays for disadvantaged people, works councils, etc. The
principle is that holidays should be offered, at very reduced rates, to
charities or local authority social welfare centres in contact with the
most disadvantaged so that they can organize holidays for families with
social problems. Holidays cost from EUR 38.11 to EUR 106.71 per person per week.
In 2000, 10,000 people were thus able to go on holiday, often for the
first time. Special rates have been introduced by the SNCF (French
Railways) and Air France;
- the coupon sport (sport
voucher) allows children from low-income families to obtain a
reduction of the membership subscriptions for approved sports associations1.
130,000 families benefited from this measure in 1999, and 200,000 in 2000.
Close on half of the beneficiaries were aged between 10 and 13. The ticket
sport (sport ticket) helps young people who are not able to go away to
play a sport during their school holidays.
Coping with
social emergencies
Alongside prevention
measures, action needs to be taken to deal with the extreme situations of
the homeless and destitute. Several measures have been introduced to deal
with these cases of social emergency:
A departmental "social watch":
Each department has to have
one of these schemes, operating twenty-four hours a day, in order to
provide information and guidance for people in distress. All departments
already have a "115" telephone line for help for the homeless.
The 115 line can be run as part of a special reception service
coordinating all the players and therefore able to assess actual needs.
The CHRS (centres d'hébergement et de réinsertion - accommodation
and social re-integration centres) play a key role in these schemes. These
establishments do not all provide accommodation, but can give guidance and,
if necessary, help people reintegrate into society. Since 1997, 1,690 new
beds have been created, making it possible to set up 19 help and guidance
services. 92 of these centres are now able to take in families and not
just single people.
The CASU (commissions de l'action
sociale d'urgence - emergency social action commissions): these
were set up in all departments at the beginning of 1999. Their purpose is
to put people asking for assistance in contact with the requisite person
so that they can explain all their problems without having to approach a
whole range of people, to ensure that the applicant receives a
comprehensive service at the earliest possible opportunity and to find
solutions to emergencies efficiently and in a way which respects people’s
dignity. A departmental charter supported by most of the partners
concerned has been drawn up in most departments. These charters lay down
methods and rules for the coordination of the various participating
bodies.