The term ‘Medical Desert’ has become established in public debate as a way of describing the difficulties in accessing healthcare in certain areas. Although it does not correspond to any official legal category, this umbrella term has become a central point of reference in discussions concerning the distribution of healthcare professionals and regional health inequalities. Its success in the media and in politics stems from its ability to highlight a complex phenomenon involving a shortage of healthcare professionals, longer waiting times for appointments and increasing difficulties in accessing healthcare.
In its most common sense, “Medical Desert” refers to the inadequacy of the available healthcare provision relative to the needs of the population. This situation has a dual dimension. On one hand, a spatial dimension linked to the distance separating patients from healthcare professionals. On the other hand, a temporal dimension, which manifests itself in longer waiting times for appointments and a reduction in the amount of medical time available per patient.
Article 35 of the Charter of Fundamental Rights of the European Union sets out the right to health protection. This right to health protection is a constitutional objective derived from paragraph 11 of the preamble to the French Constitution of 1946. The various aspects of the right to health protection demonstrate that it is essential to every human being.
Through this report, ASSEDEL aims to help improve access to healthcare in France and to contribute, at least in part, to resolving the issue of “Medical Deserts”. The authors of this report are not medical experts, but in drafting this text they have drawn on two interviews with doctors, three with medical unions, and a pilot survey of around thirty students.
The ASSEDEL report is divided into three parts: a presentation of the situation, the solutions put in place by France and their reception, and finally the recommendations. The presentation of the situation offers a particularly important perspective in that it specifically addresses, in part, the situation in the overseas territories. As for the section on societal reactions and recommendations, the report is based on interviews with numerous medical unions and professionals, highlighting just how vital the views of medical professionals and medical students are.
Firstly, the causes behind this phenomenon of “Medical Deserts” are many and varied. These include the numerus clausus, which has led to a shortage of doctors in France; the ageing of the medical workforce – in France, one in two practising general practitioner is over 55 years old and nearly 15% of doctors are over 65; the heavy administrative burden; and finally, the broader issue of regional attractiveness.
In response to these problems, successive legislators and governments have introduced various solutions: public service commitment contracts (CESP), the scheme for regional general practitioners, health centres, the development of teleconsultation, the abolition of the numerus clausus, mobile medical clinics, and finally the Pact to Combat Medical Deserts.
However, this legislative and governmental zeal is not always welcome. The two Mouiller and Garot bills have been the subject of much debate among medical unions, which have consistently voiced their opposition to them.
A section of the ASSEDEL report is devoted to the specific challenges faced by France’s overseas territories. In terms of healthcare, the overseas territories present significant epidemiological characteristics, against a backdrop of socio-economic conditions that are more unfavourable than in mainland France. Despite growing demographic and health challenges, healthcare provision remains inadequate in certain territories and struggles to adapt to changing needs. Access to healthcare in the overseas territories remains highly unequal, both in comparison with mainland France and between the various overseas territories, and even within a single territory.
The ASSEDEL report concludes with a list of 10 recommendations addressed to policy-makers, including the promotion of the draft bill proposed by the ReAGJIR union, the expansion of higher education provision in the territories, and a clear stance against the regulation of doctors’ practice locations.
Access to healthcare affects every human being; it is essential that we safeguard it.
Read ici le rapport complet.