[How can accessibility measures be improved to better target underserved areas?] / Comment améliorer les mesures d'accessibilité aux soins pour mieux cibler les zones sous-denses ?

ABSTRACT

INTRODUCTION: Compared to the other countries of the Organization for Economic Cooperation and Development (OECD), France now enjoys an average level of medical staffing. Yet accessibility to healthcare is a major public policy issue because of the unequal distribution of health professionals throughout the French territories; the authorities are trying to fight the problem by deploying a set of measures favoring the installation and maintenance of healthcare services in areas identified as underserved. OBJECTIVES: The identification of underserved zones raises the question of what healthcare accessibility measures exist for clarifying the situation in the territories. Localized potential accessibility calculated at the municipal level has been used since 2017 as a criterion for the national selection of underserved areas. We show how this indicator represents an advance in the measurement of accessibility to care, but we also discuss the limits. Proposals for improvement are put forward. METHODOLOGY: Taking advantage of the availability of new databases, we propose for the Île-de-France region an infra-communal APL indicator that is calculated at a more appropriate geographical level, integrates better consideration of mobility practices linked to the use of care, and takes into account the social aspect of healthcare needs. RESULTS: This type of indicator represents an important step forward in measuring territorial disparities in access to care. As in other countries, and in France for other fields, its use as an instrument of public policy raises questions related to the derivation of an operational indicator for delineating areas of action.