Medical Deserts in France

“87% of France is a medical desert,” declared the Deputy Secretary of the French Department of Health and Prevention in December of 2022. Although medical deserts are currently a hot topic in France, the debate has been going on and off the news for decades. In 1979, Simone Veil, then Secretary of Health, affirmed that there were no more medical deserts in France, justifying a reduction of the numerus clausus (annual cap on the number of medical students). The argument was that too many physicians would inflate health care demand and thus cause rising costs, in the context of a country having publicly funded universal coverage. 

Today, with an aging population and a growing prevalence of chronic conditions, and after three decades of cost-control strategies, there seems to be a misalignment between supply and demand of care. Yet, there is still no official definition of what a medical desert is. Under which threshold must action be taken? What is the appropriate rate of physicians per population? How much is too long a distance to see a doctor? When do waiting times for an appointment exceed the reasonable? Are allied professions a valid alternative of GPs for primary care? How realistic is it to refer to deserts in a country that is smaller than Texas?

A comprehensive healthcare reform was launched in 2018 by president Macron. It includes efforts in regional coordination of healthcare providers, medical school admission reform, delegation of medical acts, and access to telemedicine. The reform resulted in a major antagonizing of health professions. Medical students oppose the modification of their curriculum, complain about burn-out and mistreatment. General practitioners are out in the street criticizing the government and asking for better pay. Virtually every national media echoes the diagnostic of a healthcare system in crisis. The medical deserts issue thus turn into a perfect case study to analyze the dynamics of health politics in France.

Bio

Dr. Elisa Chelle is Professor of Political Science at the Department of Law and Government at the University Paris Nanterre, France. She also is an affiliate researcher at Sciences Po and has recently been distinguished fellow of the Institut universitaire de France for a research project on medical education reform. She serves as editor of the academic journal Politique Américaine since 2020. She is currently visiting professor at the CUNY Graduate Center.

Her research covers topics in health politics, inequality, and philanthropy, focusing on policy transfers between the United States and France. She has authored or edited four books, including Comprendre la politique de santé aux États-Unis (2019) – that is the first book ever written in French about the American healthcare system –, as well as 30 articles or book chapters. She appeared or was quoted in multiple national media outlets (France Info, France Culture, France 24, Europe 1, Radio France International, Le Figaro, Le Point…).

Prior to joining the University Paris Nanterre, Elisa Chelle taught at Sciences Po Grenoble, France, Sciences Po Rabat, Morocco, University of Lausanne, Switzerland, and University of Lyon-3, France. She was a visiting doctoral fellow at NYU and postdoc at the Canadian Institutes for Health Research. She worked as a policy officer for the French Ministry of Health and Social Affairs and as a consultant for the Council of Europe. Her Ph.D. dissertation on experimental anti-poverty strategies in the US and in France was awarded the Early-Career Research Prize of the Institut de France / Caritas Foundation.