Medical deserts, fee overruns: UFC-Que Choisir is sounding the alarm

Bills in Parliament, addition of a fourth year of internship in general medicine… The fight against medical deserts has returned, in recent months, to the heart of public debate. And the alerts multiplied:62% of the 12 million Ile-de-France residents have insufficient access to a general practitioner”, worried in our columns in October the boss of the ARS of Île-de-France, Amélie Verdier.

But how extensive are the medical deserts in France? Anxious to answer this question, the UFC-Que Choisir publishes, this Tuesday, an interactive map, so that everyone can check access to care from their municipality. Criticizing “the intolerable health divide” which undermines the territories, the consumer association also underlines “the deplorable state of geographic and financial access to healthcare in France“.

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To create its map, the association looked at four professions: general practitioners, ophthalmologists, gynecologists and pediatricians. She relied onlocalized potential accessibility“, an indicator used by the statistical service of the Ministry of Health to “measure the spatial adequacy between supply and demand for primary care at a detailed geographical level“. UFC-Que Choisir then related this offer to the rates charged, to take into account “geographical remoteness and the financial capacity of users to receive treatment“. It thus looked at three levels of pricing: doctors with no fee overruns, those with a moderate overrun and all professionals, including those with a significant overrun.

Thanks to these indicators, the UFC has developed a classification of municipalities in relation to the national average. A medical desert is an area where “geographical accessibility is at least 60% lower than the national average», and a municipality with a «difficult access“to care is classified”between 30% and 60% below the national average“.

This work done, the finding is worrying to say the least. With regard to general practitioners, the medical deserts strictly speaking concern 2.6% of the population, or 1.7 million people. However, 23.5% of users, ie almost a quarter of the population, would experience difficulty in accessing this link in the health course within 30 minutes by road and would therefore live in an area with difficult access.

A particularly degraded situation in “peripheral” France

Beyond general practitioners, the finding is also worrying for the three specialties studied by UFC-Que Choisir. Thereby, “19% of patients (12.3 million people)would live in an ophthalmological medical desert, according to the association. The situation is even more worrying for gynecologists and pediatricians: 23.6% of women live in a medical desert, in the first case, and 27.5% of children, in the second case. Much higher figures if we take into account the populations with access difficulties, beyond the medical deserts alone.

Despite the extent of the difficulties, disparities remain according to the territories. “In general, the type of territory is a major determinant of the health divide: the situation is particularly degraded in France “peripheral” : rural outskirts of large urban centers, rural municipalities, outskirts of small and medium-sized centers», Specifies the consumer association. The department of Sarthe and a large part of Nièvre are particularly under-resourced for all four professions analyzed by UFC-Que Choisir. “On the contrary, the Mediterranean coast, the Atlantic coast, the mountains and the major urban centers seem attractive for doctors.», specifies Maria Roubtsova, in charge of health mission at the association.

The UFC calls on the State to regulate the installation of doctors

The analysis becomes even more worrying by including the financial criterion. By taking into account only the doctors practicing a rate of excess fees of 50% maximum, the figures worsen for the specialists. 39.2% of people would then find themselves in a medical desert as far as ophthalmology is concerned: in other words, more than one in three people would not have easy access to an ophthalmologist whose excess fees are “moderate“. A figure that stands at 32.8% of children for pediatrics and 54.7% of women for gynecology. Taking this criterion into account, the association observes that “medical deserts affect both rural and urban areas“: “It is especially the big cities that are affected by high fee overruns. This creates a problem of accessibility to care, in financial terms for the inhabitants“, points out Maria Roubtsova.

Faced with this situation, UFC-Que Choisir calls on the public authoritiesto change logic by regulating the installation of doctors (such a regulation exists for the installation of liberal nurses) and by putting an end to the fever of fee overruns“. Physicians could no longer settle in “overstaffed areas“, unless you follow the Social Security tariffs, “when the situation calls for it“. A politic “stick» rather than «the carrotwhich is privileged today.

Read alsoSocial security budget: revolt in the majority behind an anti-medical desert measure

Still, his calls are likely to be little heard. In mid-October, faced with attempts by elected officials on all sides to regulate the installation of doctors, the government reiterated its firm opposition to any coercive measure. “Not out of dogma, but because it doesn’t work”had then hammered François Braun, Minister of Health.

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