“Specialized medicine is even more affected by healthcare withdrawal than general medicine”

Héléna Revil on April 21, 2022 in Grenoble.

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 sciences laboratory, explains the different factors of giving up care.

While physician density has deteriorated in recent years in many specialties, what about the neglect 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 forgoing care.” It led to the following result: one person in four declares to have abandoned at least one treatment during the last year.

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When we question the causes, we can clearly see that it is a mixture of explanations. A large part is due to economic reasons. This encompasses the fact of not being able to finance the rest to pay for a consultation, treatment, or advance costs, but also the uncertainty and vagueness around the final cost of care that often dominates people’s heads, leading to some give it up early. 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 to function in the health system, to find professionals who accept new patients, fear of diagnosis…

Are the rural departments, most affected by desertification among specialists, the most concerned?

The renunciation appears more strongly in certain territories than in others. Together with this average of 25% of people who say they have abandoned treatment, the rates thus range between 12% and 35%. We find the departments with the lowest levels of waiver in Corsica or in the Northeast (Meuse, Moselle, Haut-Rhin) and, at the other extreme, the highest in various departments of Ile-de-France, but also more in the center , with Lozère or Allier, or even in the south, in Drôme, Bouches-du-Rhône, Aude, Hérault, Tarn…

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It is very present in the rural world, but also in the city, because the supply of care is often poorly distributed. Behind the issue of access times arises the lack of professionals and their distribution. At the same time, the problem of cost overruns is also more or less marked.

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