Tackling medical deserts in France
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Tackling medical deserts in France

The advantages of mandatory policies

Policy Paper
By Benjamin Montmartin, Sean Scull & Frédérique Vidal
Recommendations

1. Prioritise regulation of doctors’ practice locations

Extend the practice of ‘selective contracting’ to private medical practice. A doctor would only be authorised to contract if another doctor in the same specialty leaves or retires. This is in line with Loi Garot, whose selective contracting mechanism aims to mandate practice set-up in underserved areas.

Increase the number of public service commitment contracts enabling medical students to practise in underserved areas in exchange for a grant.

These regulatory measures could then be reinforced by:

2. Incentive-based voluntary policies

Attract doctors to medically underserved areas by offering them financial benefits. This solution preserves doctors’ freedom to choose where they practise (voluntary policy), while encouraging them to establish their practice in an area with low medical density. Incentives include direct financial assistance in the form of grants or subsidies to cover the doctor’s set-up costs, enhanced remuneration through higher consultation fees, and additional payments for services provided in underserved areas. Tax exemptions, relief on social security contributions, housing assistance and student loan repayments are other financial incentives designed to attract doctors to these underserved areas.

Attract doctors to medically underserved areas by offering them professional or personal benefits. These non-financial incentives include improved working conditions (opportunity to practise in multiprofessional health centres, access to cutting-edge equipment), support for continuing education, reduced administrative workload (secretarial support), access to telehealth services, and family support measures (access to schools, cultural and sports activities).

Encourage the establishment of health centres to reduce the isolation and workload of private practitioners.

3. Reorganise medical training

Develop targeted training programmes and recruit medical students from areas with low medical density who wish to work in rural settings.

Strengthen multidisciplinary approaches during training and create an ‘advanced rural practice’ pathway enabling paramedical professionals to help ease the pressure on doctors in underserved areas. This could include immersive internships in rural areas.

Summary
Resources

Introduction

The high geographical concentration of private practice doctors in France poses major challenges for the healthcare system, particularly because it creates so-called ‘medical deserts’. This phenomenon has been worsening over the past several years. France Inter reported that sixty-nine départements have seen their medical (physician) density decline between 2010 and 20241. This multiplication of medical deserts is leading to increased difficulties in accessing healthcare and reinforcing inequalities between areas that are well-served and those that are not.

Given the scale of the problem, government initiatives have been introduced to address the issue of medical desertification. Two main approaches are under discussion: mandatorypolicies on practice locations and voluntary, incentive-based policies. The first approach would require young doctors to work in underserved areas for a set period of time. This could ensure a more equitable geographical distribution of healthcare access and help meet public service needs. Regulating practice locations may reduce inequalities in healthcare access and provide a rapid solution to meet the needs of the population. However, by restricting the freedom to choose where to practise, this type of policy can negatively affect both the availability and the quality of care, as a doctor forced to work in a specific area may become demotivated, reduce their working time and become less committed to their work. The second approach, based on volunteering, uses financial and non-financial incentives to encourage doctors to settle in underserved areas, while respecting their freedom to choose their practice location. The incentives include practice set-up grants, tax exemptions and improvements to working conditions, all of which help make these areas more attractive. This second option is generally easier to implement, because a non-coercive approach is more acceptable to doctors in private practice. It is worth noting that in France, doctors currently enjoy full freedom to choose their practice location. Few other countries allow such an approach.

The geographical distribution of doctors, particularly those in private practice, is a major challenge for the French healthcare system. The aim of this study is therefore to shed light on the following issues: What explains the emergence and growth of ‘medical deserts’ in France? Which policy approach is the most effective in tackling ‘medical deserts’: regulation or incentives?

Based on the work of Benjamin Montmartin, professor of econometrics and data science at SKEMA Business School and director of the Chair for Prevention and Access to Healthcare, this study examines the organisation of private healthcare in France and the effectiveness of regulatory and incentive policies to combat “medical deserts.” The study also provides a comparative analysis of public policies implemented in other countries.

Download the full analysis

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Source
  1. France Inter, (2025, February 28). Les déserts médicaux : quelles conséquences pour notre santé ? France Inter. https://www.radiofrance.fr/franceinter/podcasts/une-semaine-en-france/le-18-20-une-semaine-en-france-du-vendredi-28-fevrier-2025-5795838 ↩︎
benjamin montmartin
Photo de Sean Scull
Frédérique Vidal
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