It is a sea serpent on which many have tried, and broken their teeth: should the freedom of installation of doctors be restricted? The question could have made a good subject for the philosophy baccalaureate on Wednesday. But rather than high school students, it is the deputies who are thinking about the issue. This week, the Assembly began the examination in first reading of a text carried by the presidential majority aimed at fighting against medical deserts.
The proposed law (PPL) intends in particular to “increase the participation of health establishments in the continuity of care”, prohibit temporary work at the start of their career for certain caregivers, and offer, from the third year, the possibility for students in medicine to receive a monthly allowance against an engagement in a medical desert. A transpartisan amendment wanted to go further: to settle in an already well-endowed sector, liberal doctors and dental surgeons would have to obtain authorization from the Regional Health Agency (ARS), conditioned for example on retirement or the relocation of a doctor carrying out the same type of activity. It was defeated Wednesday evening, and the proceedings continue from Thursday. But how are our European neighbors faring on the subject? Are they stricter? François Braun, risks “rotting the situation”. 20 Minutes takes stock.
German density thresholds
A first answer is to be found across the Rhine. Faced with rapid aging and an East/West and town/country imbalance in its medical density, Germany launched a statistical study in 1976 on the distribution of doctors in the country. In 1993, the reunified country saw its territory divided into 395 planning zones (urban, peri-urban and rural). This health needs plan, or “ Bedarfsplanung », conditions the installation of new general practitioners and specialists to various criteria: population density, number of doctors per inhabitant, age of the doctors or, since 2013, age and sex of the population. And, since 2021, state of health of the population.
These factors make it possible to draw up density thresholds in a fine and targeted manner. New doctors and specialists can therefore only set up in areas where the ratio of doctors per inhabitant exceeds 110% of the target. Beyond that, no additional authorization is issued, making Germany one of the countries where the installation of new practitioners is the most strictly regulated.
However, it is possible for health professionals to circumvent this constraint. “Only city doctors of all contracted specializations are subject to it, specifies the National Observatory of the Demography of Health Professions (ONDPS). Non-conventioned doctors, also called “private doctors”, are free to settle where they choose, regardless of the Bedarfsplan “.
Spanish planning
Subject to an aging of its population comparable to that of France, and to strong disparities in density, Spain has also conditioned the installation of its new doctors to a set of criteria. The health system there is subject to strong planning by the autonomous regions. They “formulate needs in terms of staff to be trained by specialty”, and “decide on the location of health centers where specialists and general practitioners practice in town, and therefore doctors”. The latter are also “employees of the regions”, indicates the ONDPS.
Financial incentives are also proposed to encourage doctors to practice in areas where there is a shortage of healthcare supply. Measures which allowed a better distribution of doctors, but which were not enough to effectively rebalance the strong regional disparities.
More flexible, Belgium has opted for an incentive system to encourage doctors to settle in the most under-resourced territories. Wallonia, the region where medical desertification is the strongest, grants bonuses via the General Medicine Impulse Fund to support the installation of young doctors in areas with shortages.