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In 2019, a study showed that some practitioners refused to consult people receiving health assistance (complementary health care, state medical assistance). Three years later, a follow-up study shows that this discrimination is on the decline. They nevertheless persist for the beneficiaries of the AME.
The Defender of Rights and the Ministry of Health and Prevention are making public the results of a study on the refusal of care by beneficiaries of complementary health care (CSS) and state medical aid (AME ), in three medical specialties: general medicine, ophthalmology and paediatrics. This study is based on a telephone test carried out between March and September 2022 with more than 3,000 practitioners.
Evaluate the refusal of care on fragile populations
This study, conducted by a research team from the Institute for Public Policy, is based on telephone testing for which 34,000 calls were made. It was carried out between March and September 2022 with more than 3,000 practitioners.
The objective is to assess whether there is discrimination in access to care for the most vulnerable populations, those benefiting from CSS, AME and those called “reference patients” who do not declare receiving either of these two types of aid. . complementary universal health cover (CMU-C) and assistance with the payment of complementary health insurance (ACS). Discrimination is measured through the rates and delays in obtaining a medical appointment.
Difficulty of access to care for all
Only half of the patients requesting care for a non-urgent reason obtain an appointment with a general practitioner, an ophthalmologist or a pediatrician. Four calls are needed, on average, to get in touch with a medical practice.
For people who have obtained an appointment, the times offered are sometimes very long: within 8 days for general practitioners, 25 days for pediatricians and more than 55 days for ophthalmologists.
No discrimination to obtain an appointment in case of CSS (CMU-C and ACS)
Overall, patients benefiting from the CSS obtain a medical appointment in the same proportions as reference patients. This result contrasts with those of previous testing studies on access to care for CMU-C and ACS beneficiaries. However, discriminatory refusals remain explicitly formulated in 1 to 1.5% of cases.
Recognized and explicit refusals of care for AME beneficiaries
On the other hand, the study highlights discrimination against AME beneficiaries: on average, they have to call 1.3 times more than reference patients to obtain a medical appointment. Compared to reference patients, AME beneficiaries have between 14 and 36% less chance of having an appointment with a general practitioner, between 19 and 37% less chance with an ophthalmologist and between 5 and 27% with a paediatrician, regardless of the practitioner’s gender and sector of practice.
Although this discrimination is the result of a minority of practitioners, it is not insignificant in scale and is often expressed explicitly: 4% of requests for appointments by patients benefiting from AME with a general practitioner result in a refusal. explicit discrimination, 7% of calls for an appointment with a pediatrician and 9% of calls with an ophthalmologist. Overall, nearly one out of ten refusals to meet with AME beneficiaries is explicitly discriminatory.
Let us recall that these refusals of illegal care (whether overt or disguised) vis-à-vis universal access to care and run counter to the general interest in terms of public health prevention and early detection of pathologies, their treatment…).
The study puts forward avenues that could explain these refusals of care: prejudices according to which the management of these patients would be more complex (patients in less good health, with little or no command of French, longer consultations, etc.), anticipation heavier administrative procedures (these patients do not benefit from the Vitale card).
Less frequent refusals of care
According to the authors, “the merger of the CMU-C and the ACS into the CSS in November 2019 and the extension of the practice of third-party payment seem, on the other hand, to have made it possible to simplify the management of the service for health professionals and thus participate in reduction in refusals of care for CSS beneficiariesHowever, the situation remains difficult to compare knowing that the specialties were different. psychiatrists
For his part, the Defender of Rights recalls that a “discriminatory refusal of care against a beneficiary of targeted aid, because of his situation of economic vulnerability, is an offense under the law, and an act contrary to professional conduct and medical ethics“.