Jusot F
CREAM, université de Rouen, 3, avenue Pasteur, 76186 Rouen cedex 1, France.
Rev Epidemiol Sante Publique. 2013 Aug;61 Suppl 3:S163-9. doi: 10.1016/j.respe.2013.05.011. Epub 2013 Jul 9.
Tackling health inequalities is one of the main public health goals, and equity of access to care is a necessary condition to achieve this objective. Analyzing and assessing inequalities in health care use is therefore essential in order to enlighten public health policies. This article proposes a review on inequalities in access to care in France and OECD countries, their causes and their evolution. During the last decades, inequalities in health care expenditure have decreased in France with diffusion of complementary insurance, due in particular to the CMU-C implementation in 2000, but they are still significant. The reduction of inequalities is particularly important for GP use, for which we observe now pro-poor inequities. However, there are persistent and important inequalities in access to specialist care, as well as in preventive care. Therefore, France is still one of the European countries with the highest level of inequities in access to care.
解决健康不平等问题是主要的公共卫生目标之一,而医疗服务可及性的公平性是实现这一目标的必要条件。因此,分析和评估医疗服务利用方面的不平等对于为公共卫生政策提供依据至关重要。本文对法国和经合组织国家在医疗服务可及性方面的不平等、其成因及演变进行综述。在过去几十年里,由于补充保险的普及,尤其是2000年实施的全民医保补充保障计划(CMU-C),法国医疗保健支出方面的不平等有所减少,但仍然显著。不平等的减少对于全科医生服务的利用尤为重要,目前我们观察到在这方面存在有利于贫困人口的不公平现象。然而,在专科护理服务的可及性以及预防性护理方面,仍然存在持续且严重的不平等。因此,法国仍是欧洲国家中医疗服务可及性不平等程度最高的国家之一。