The Observatory of the French mutual provides a worrying panorama in its latest study on geographical inequalities in access to care. In 2018, 11% of French people lived in a medical desert compared to 7.6% in 2012.
- According to the Observatory of the French mutual, inequalities in access to care are widening. In 2018, 11% of French people live in medical deserts.
- Rural areas are the most affected by this phenomenon. Geography where a large part of the population is over 60 and needs to consult more regularly.
Guaranteeing equal access to care throughout the territory is an old sea serpent of French health policy. In his latest report published this friday 2 october, the Observatory of the French mutual is interested in this thorny question and reveals indicators of deterioration of the situation. Thus, if the report notes that the average density of doctors in France is 339 per 100,000 inhabitants in 2019, a rate within the European standard, this medical population is very poorly distributed. “The highest density is in Paris (626 specialists per 100,000 inhabitants), then in Rhône (280) and Alpes-Maritimes (277); conversely, Eure, Meuse, Ain and Mayenne have the lowest densities (between 70 and 80 doctors per 100,000 inhabitants)”. ensures the Observatory.
However, this imbalance is widening and causing medical deserts, that is to say areas where the inhabitants cannot on average consult a general practitioner more than 2.5 times a year. If 7.6% inhabitants met this definition in 2012, they represented 11.1% or 7.4 million people in France in 2018, to suffer from this absence of a general practitioner. The most affected areas? Rural areas like the center and northwest, as well as the outer suburbs of small towns and metropolises.
This phenomenon also affects medical specialists. Like general practitioners, they are concentrated in large urban centers and thus widen geographical inequalities. “The density of gynecologists in Paris is more than 9 times higher than that observed in the Lot, and the density of ophthalmologists is nearly 12 times higher than that existing in Lozère”. illustrates the study. The consequence ? “The median time to obtain an appointment with an ophthalmologist is 29 days in Paris when it is 71 days in municipalities outside the influence of urban centers and 97 days in municipalities of small and medium-sized centers. In addition, 5.2 million people carry out consultations outside of the care pathway, that is to say without going through a general practitioner, for lack of finding a practitioner able to accommodate additional patients. The absence of an attending physician mainly affects the south-west and Île-de-France.
Aging patients and physicians
The finding is all the more alarming in that it mainly affects residents who are in high demand for care: the over 60s. However, this segment of the population lives mainly in rural areas shunned by doctors. This situation is likely to deteriorate with the aging of the population. According to projections by the French Mutual Observatory, the over 60s currently represent 27% of the population, and 32% in 2050.
To make matters worse, time also does its work on the medical population. Today, 45% of general practitioners are over 55 and should retire, but the succession is not as numerous. A non-renewal caused by the drop in the numerus clausus applied in the 1980s and 1990s. Today, public health policies are trying to reverse the trend with the abolition of numerus clausus in 2020 replaced by an opening of places according to territorial needs, the multiplication of health centers as well as support for telemedicine.
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