Brücker G, Nguyen D T, Lebas J
Service Vigilance Hygiène Prévention-DPM/DIREQ, Paris.
Bull Acad Natl Med. 1997 Nov;181(8):1681-97; discussion 1698-700.
All legal French residents are entitled to health care. The 1992 regulatory measures, which create a contractual agreement between the government and public medical institutions, aim at facilitating access to health care by resolving the financial obstacles to accessing health care. The Assistance Publique-Hôpitaux de Paris (AP-HP) has set up a medical reception center in several hospitals since 1993. This system is integrated in the general structure of each hospital: in some cases, there is a single and centralized unit; in other cases, all departments of the hospital, including the emergency room, are involved in caring for destitute patients. Whatever the type of the structure may be, social workers are a key element to helping the patients recover their social rights. Thirty to seventy-percent of patients visiting these centers regain access to social and health care coverage. The epidemiological survey of the active file of patients revealed that 70% are male, more than 50% are non-French nationals, half of which do not have legal immigration status in France. Homeless people represent 40 to 80% of the population. The average age is around 35. The number of medical visits varies greatly from one hospital to another and range from 20 to 60 per month. The reasons for visiting the center and the identified medical disorders are strongly related to the patients' life conditions and vary significantly with the risk factors related to the social and economic situation. The frequency of some diseases (psychiatric disorders, tuberculosis, infections by the HIV and HCV) is higher in this population than in general population. Delayed visits to the medical center represents a severity factor. The hospitals' mission statement is not only to ensure that patients facing a precarious social and professional situation have equal access to health care, but also to help such patients recover their social rights, facilitate their integration in the society and fight against social exclusion.
所有合法的法国居民都有权享受医疗保健。1992年的监管措施在政府与公立医疗机构之间建立了契约协议，旨在通过消除获取医疗保健的经济障碍来促进医疗保健的可及性。自1993年以来，巴黎公共救助医院集团（AP-HP）在几家医院设立了医疗接待中心。该系统融入了每家医院的总体架构：在某些情况下，有一个单一的集中单元；在其他情况下，医院的所有科室，包括急诊室，都参与照顾贫困患者。无论结构类型如何，社会工作者都是帮助患者恢复其社会权利的关键因素。前往这些中心就诊的患者中有30%至70%重新获得了社会和医疗保健覆盖。对患者活动档案的流行病学调查显示，70%为男性，超过50%为非法国国民，其中一半在法国没有合法移民身份。无家可归者占人口的40%至80%。平均年龄约为35岁。不同医院的就诊次数差异很大，每月从20次到60次不等。前往该中心的原因以及所确定的医疗疾病与患者的生活状况密切相关，并因与社会经济状况相关的风险因素而有很大差异。该人群中某些疾病（精神障碍、结核病、艾滋病毒和丙型肝炎感染）的发病率高于普通人群。延迟前往医疗中心是一个严重因素。医院的使命不仅是确保面临不稳定社会和职业状况的患者能够平等获得医疗保健，还要帮助这些患者恢复其社会权利，促进他们融入社会并反对社会排斥。
