The long-term illness (affections de longue durée - ALD) provision was put in place when the social security system was first established, to deal with patients suffering from a chronic condition which requires prolonged treatment and a particularly expensive course of therapy.
A list confirmed by decree specifies 30 conditions (ALD30); patients suffering from these illnesses are not required to pay anything towards their treatment (these include malignant tumours, diabetes, long-term psychiatric conditions, heart conditions etc.). Granting of this status is subject to an application to the patient's social security centre, and approval by the medical services.
In practice, almost all conditions which are usually serious in nature are covered by the ALD arrangements (this includes cancers, heart conditions, HIV infection, diabetes, serious mental health issues etc.).
The law of 13 August 2004 amended the ALD arrangements. Amongst the most notable terms of this new law is the new protocol established to define the course of treatment to be followed by patients newly receiving ALD status. This treatment schedule is drawn up by the doctor responsible for the patient's care, validated by the medical insurance board's advising doctor and finally signed by the patient.