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ORIGINAL FRENCH ARTICLE: Les plus pauvres sont les plus mal soignés

by Maud Dugrand

The Poor Get the Worst Health Care.

Translated Monday 29 October 2007, by Gene Zbikowski

An edifying INSEE study confirms that the poorest households suffer discrimination in access to health care, following a study on health care conducted between 2002 and 2003.

The least one can say is that the INSEE study entitled “The Health of the Very Poor,” which was published yesterday, comes at just the right moment. Right in the middle of the debate on the social security budget bill in the French National Assembly, right in the middle of the battle against medical co-payments, the day after the demonstration by medical students, the health care study conducted between 2002-2003 with a sample of 40,000 people confirms the discrimination in health care access suffered by the poorest French households.

A Greater Proportion Go to the Hospital.

The French poor and their children do not go to see the family doctor very often, and they see specialists even less. Some 21% of the under-50s did not see the doctor, as against 17% of that age group in the rest of the population. And even when they do go to the doctor, “it’s often when the condition is already serious,” noted Thibaut de Saint Pol, an INSEE sociologist. A disproportionate proportion of the most fragile households also go to the hospital. About 19% of them had been hospitalized in the year preceding the study, against 16% for the rest of the population. As concerns specific conditions, tooth decay is at the head of the list. Among the poor, 11% suffer from tooth decay against 6% of the rest of the population. The same goes for poor French children: they are less likely to benefit from orthodontic care (6% against 10% for other children) and they also suffer more from tooth decay, 6% against 2%. These children are also more likely to be asthmatic, 6% against 4%. The poor also suffer more from rheumatism, varicose veins, osteo-articulatory illnesses, degenerative osteoarthritis and backache.

Paradoxically, the poorest French people report certain widespread conditions less, such as vision ailments. About 51% report at least one eye ailment, short-sightedness or far-sightedness, against 60% of the rest of the population. The difference is due to these ailments going undetected, which results from seeing the doctor less. "And then people who have a headache don’t automatically think to see the doctor, because the relationship to the body may be different,” Thibaut de Saint Pol emphasized. As a result, access to preventive care is very unequal: among 40-year-old women from deprived households, 34% have never had a mammography against 19% for other women. The same goes for smear tests: 12% of poor women have never had a smear test, against 6% for the rest of the population. The same differentials exist as concerns tests to detect HIV, hepatitis C, and rectal bleeding (a sign of colon cancer). Finally, it is no surprise to learn that 22% of those living on a very low income have no supplementary health care insurance, and that due to a lack of information, the poor do not always ask to benefit from the system of free health care for those on low incomes (C.M.U.), whereas others are excluded because their income is just over the ceiling for admission. For all that, it is well to bear in mind that the poor are not responsible for the debt run up by the social security system since their medical consumption is lower than that of the rest of the population.

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