Héléna Revil, researcher in political science at the University of Grenoble-Alpes, scientific manager of the Observatory of non-recourse to rights and services of the Pacte social science laboratory, explains the different factors of the renunciation of care.
While the density of doctors has deteriorated in recent years in many specialties, what about the renunciation of care among patients?
Between 2014 and 2020, before the health crisis, we conducted a large-scale survey with Medicare covering 160,000 people, the “barometer of the renunciation of care”. It led to the following result: one person in four declares having given up on at least one treatment during the past year.
When we question the causes, we can clearly see that it is a question of an intermingling of explanations. A large part comes down to financial reasons. This covers the fact of not being able to finance the remainder payable for a consultation, treatment, or to advance the costs, but also the uncertainty and vagueness around the final cost of the care which very often dominates in the head of people, leading some to give it up in anticipation. Then comes the question of the waiting time to get an appointment. All of this can add up: having to wait eight months, when you have limited and unstable resources, can make you hesitate to make an appointment.
Other explanations also coexist: difficulties in navigating the health system, in finding professionals who accept new patients, fears of diagnosis…
Are the rural departments, more strongly affected by desertification among specialists, the most concerned?
Renunciation appears more strongly in certain territories than in others. Alongside this average of 25% of people who say they have given up treatment, the rates thus range from 12% to 35%. We find the departments with the lowest levels of renunciation in Corsica or in the North-East (Meuse, Moselle, Haut-Rhin) and, at the other end, the highest in several departments of Ile-de-Francebut also more in the center, with Lozère or Allier, or even in the South, in Drôme, Bouches-du-Rhône, Aude, Hérault, Tarn…
It is very present in the rural world, but also in the city, because the supply of care is often poorly distributed. Behind the question of access times arises that of the lack of professionals and their distribution. At the same time, the problem of fee overruns is also more or less marked.
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