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Investigating a failed policy: the French state and medical demography (1960-2015)

Abstract

France has never had as many doctors as today. However, the French healthcare system is characterized by a very unequal distribution of healthcare provision, so that access to medical care becomes more difficult for growing sections of the population. This situation is all the more surprising given that, since the 1970s, the French state has equipped itself with instruments supposed to regulate the number of doctors practicing in France, both in terms of their overall workforce and their distribution between disciplines. In addition, since the 2000s, the public authorities have stepped up measures to encourage a better geographical distribution of doctors. To understand the failure of these measures, this article examines the social and political logics that have been predominant in their adoption and implementation. Based mainly on administrative records, it describes how the French state, in close relationship with the medical profession, defined the problem of medical demography from the early 1960s onwards, and what successive responses it has given it without succeeding in solving it.

Keywords:
Medical Demography; Doctors; Healthcare Inequalities; State; Public Policy

Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. Av. dr. Arnaldo, 715, Prédio da Biblioteca, 2º andar sala 2, 01246-904 São Paulo - SP - Brasil, Tel./Fax: +55 11 3061-7880 - São Paulo - SP - Brazil
E-mail: saudesoc@usp.br