“Dispersed, poorly targeted measures…”: the Court of Auditors judges the policy to combat medical deserts “poor”

“Dispersed, poorly targeted measures…”: the Court of Auditors judges the policy to combat medical deserts “poor”

Les inégalités d’accès aux soins de premier recours persistent. Midi Libre – SYLVIE CAMBON

The investigators note that the inequalities in access to front-line professionals, and in particular treating doctors, are widening and are unequal across the territory despite the multiplication of “seemingly ambitious measures”.

It’is a 172-page report "The territorial organization of primary care", which went almost unnoticed in a difficult week for health stakeholders, concluded with a draft ;agreement between doctors and Health Insurance on a consultation at 30 euros (it remains to be signed), and the growing specter of a "Black Monday", next June 3, in private clinics engaged in a showdown with the government over hospital rates.

Six days on average for an appointment with a general practitioner and less than one chance in two of getting the answer if it is not your treating doctor, 80 days for an ophthalmologist, 61 days for dermatologist… and 6.7 million French people still without a GP in September 2022, or 12% of the population, of whom 714,000 are in long-term illness (c’ was 9.3% in 2015). The observation is known. The government has committed to solving the problem by 2027.

In the meantime, the Court of Auditors is curtailing its action: "The French are finding it increasingly difficult to access primary care&quot ;, that is to say general practitioners and some specialists with direct access, pharmacists, physiotherapists, speech therapists, psychologists, nurses.

"Among patients without a treating doctor, the share of the most precarious is increasing"

She notes an "overall deterioration in access to primary care" and "a worsening of territorial inequalities" : "The average time taken to obtain appointments with doctors is lengthening, the share of patients without a treating doctor is increasing, as is the share of doctors no longer taking new patients. Among patients without a treating doctor, the proportion of the most precarious is increasing. Geographic inequalities in the distribution of health professionals are worsening. In certain territories, the rate of patients without a treating doctor can thus represent up to a quarter of patients and the rate of visits to the emergency room without any particular seriousness can reach 40%" , indicates the ratio.

He notes a "important contrast between the ambition of the measures announced and the feeling of abandonment that residents of the most vulnerable territories may feel . The proliferation of aid schemes and their instability over time make an overall consolidation of results very difficult. Although there are positive elements to note, the aid provided turns out to be ineffective if we judge by their low impact."

However, primary care weighs heavily on health: out of a total of 168.1 billion euros (152.4 in 2015) reimbursed by health insurance in 2020, 13 .3 % are allocated to primary care, indicate the magistrates, who note that "the demand for primary care is increasing" , under the effect, in particular, of demographic growth, but also of the aging of the population and the development of chronic diseases, diabetes, obesity…

In 2021, 239 million consultations were provided by general practitioners, while private specialists received 88 million visits, emergencies (public and private) recorded 20 million visits. There were also 18 million MCO stays (medicine, surgery, obstetrics) and 854 million nursing procedures.

Refusal of unscheduled care in Aveyron "for fear of being forced to agree to become a treating doctor"< /h2>

Impressive figures, which a novice could read as a sign of good health. The ace. If the supply of midwives, nurses, physiotherapists "is growing strongly", the supply of general practitioners is decreasing, likewise than those of pharmacists. That of dental surgeons is almost stable, notes the report.

In ten years, from 2012 to 2022, the population of private general practitioners has fallen by – 11.1%, – 10.4% for pharmacists, but +114.6% for midwives, whose numbers have more than doubled in 10 years, and +nbsp; 41.8% for nurses, +39.2% for physiotherapists, +29.1% for speech therapists. We went from 3,000 to 8,000 dietitians and from 38,000 to 70,000 psychologists.

Between 2015 and 2019, the overall activity of private general practitioners decreased, and the number of annual procedures per patient increased from 5.5 in 2004, at  4.2 in 2020.

At the finer scale of territories, where the density of doctors differs in proportions of 1 to 5, the inequalities are even more glaring. With more than 90 doctors per 100,000 inhabitants, the Hérault and the Pyrénées-Orientales, are, on paper, among the best-resourced departments.

Inequalities in access are "even more marked" for other health professionals, midwives, nurses and physiotherapists , indicate the investigators, who worked on the basis of 45 field surveys, and "materials collected by the regional chambers".

"In departments like Dordogne or l’Aveyron", they report "refusal of unscheduled minor emergency care for fear of being forced to agree to become treating doctors&quot ;.

In the Ardennes "a quarter of patients are without a treating doctor, twice more than the average, and 40 % of patients present themselves to the emergency room for minor problems.

"The gap observed between stated intentions and mediocre results requires a reaction of magnitude"

"Dispersed measures", "superimposed", "poorly targeted", without "relevance& quot;, the explanation of this relative failure lies, explains the report, in "the superposition of measures", " apparently ambitious", which "creates a halo effect which makes the whole thing difficult to read".

D’as long as he’is not bound by an obligation of result :"Since the beginning of the 2000s, various plans, pacts, measures have been deployed, […] monitoring of these measures is limited to counting the number of devices". "The gap observed between the stated intentions and the mediocre results requires a large-scale reaction", conclude the magistrates.

Des "indisputable successes" and policies &amp ;quot;promising", particularly in Aveyron, in the perimeter of the CPTS of Aubrac, under the leadership of the Aubrac Health Agency ;Occitanie and the CPAM, are not enough to save a disappointing record.

To change software, the report makes seven recommendations, around three axes: "Make public health policy intelligible" and he "give a guideline and effective governance", with the "need for a local decision-making body" ; "allocate aid and use available tools selectively" ; "expand the range of tools used".

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