Imagine for a moment that you are a general practitioner, ready to practice in a region where patients sometimes wait months for a simple appointment. You are seeking a premises, equipment, a welcoming structure. Logically, public funds should steer you toward the most strained areas. Yet the reality, unveiled by two successive reports from the Court of Auditors, is far from straightforward: a not-insignificant portion of multi-professional health centers funded at great expense by the community was never intended to fill a medical desert, simply because it is not located in a medical desert. A paradox that raises questions about the way policies aimed at bringing the French closer to care are conceived, targeted, and monitored.
- 125 million euros were spent by the health insurance to fund health centers, with no clear objectives or robust evaluation of results.
- One in five health centers funded by public money is located in an area without a medical shortage.
- The Court of Auditors recommends establishing, by the end of 2025, a departmental plan with zoning criteria better aligned to priority health needs.
- Public money flowed, but not always where it was needed
- How a health center can end up far from any medical desert
- Millions spent, a monitoring system left idle
- What this failure reveals for the future of underserved areas
Public money flowed, but not always where it was needed
Since the 1990s, the State has multiplied plans aimed at stemming medical desertification. But multi-professional health centers, incentive contracts, tax exemptions—the toolkit has grown over the decades without ever truly accompanying it with a comprehensive vision. The Court of Auditors, in a report on the organization of first-contact care, highlighted a dizzying figure: 125 million euros were spent by the health insurance to fund these structures intended to bring together doctors, nurses, and other health professionals under one roof.
The problem is not so much the amount as its traceability. Financial magistrates denounce an accumulation of devices implemented without clear objectives or serious evaluation of the results obtained. In other words, a lot has been spent, but it is not clear whether this money actually improved access to care where the need was most acute.
How a health center can end up far from any medical desert
This is arguably the most striking finding of the dossier: according to the Court of Auditors, one in five health centers subsidized by public funds are located in an area that experiences no medical shortage. Twenty percent of the structures intended to fight medical deserts ended up being established where the supply of care was already adequate, or even comfortable.
How can such a mismatch be explained? In the absence of genuinely refined zoning criteria and serious coordination among the various funders, projects were often approved on the fly, driven by motivated local elected officials or well-organized professional groups, without geographic placement undergoing rigorous arbitration in light of the population’s real needs. Result: communities less under pressure managed to capture funding initially designed for the most fragile areas, while other zones truly stricken medically remained without concrete solutions.
Millions spent, a monitoring system left idle
What is most striking in the Court of Auditors’ work is the near-total absence of qualitative follow-up. The assessments to date have often merely counted the number of health centers opened, without ever attempting to determine whether these centers truly attracted new practitioners or sustainably improved residents’ access to care. We measure quantity, never truly effectiveness.
This structural weakness is not limited to health centers alone. A second report, published a few months later, broadened the finding to all aids designed to encourage the installation of liberal doctors in undersupplied areas. The magistrates counted no fewer than fifteen different schemes, ranging from direct subsidies to tax exemptions, allocated in a non-coordinated way by the State, the health insurance, and the various levels of local authorities. A veritable administrative mille-feuille where each actor acts in isolation, without consultation or a shared view of priorities.
The direct consequence of this dispersion is unambiguous: the Court regards these aids as too numerous, poorly coordinated with one another, and costly and ineffective for a large portion of them. A stern verdict that mainly reflects the collective failure to turn a good policy intention into tangible on-the-ground results.
What this failure reveals for the future of underserved areas
Confronted with this finding, the Court of Auditors does not stop at pointing out dysfunctions: it offers concrete recommendations. The main one is to finally treat the fight against medical deserts as a genuine public policy, with quantifiable objectives, tracked over time at the departmental or territorial level. A way to move away from the scattergun approach and toward a more strategic method, focused on the real needs of populations rather than on a territory’s ability to assemble a funding dossier.
Practically, the magistrates call for a consultation among all funders to establish, by the end of next year, a departmental plan based on zoning criteria better suited to priority health needs. The stated objective is simple on paper: to stop dispersing public money according to local opportunities and to concentrate it where patients genuinely need it, even if that means rethinking, in depth, how underserviced zones are defined today.
As the back-to-school season rekindles the debate over access to care in rural and peri-urban areas, this dual report acts as a warning signal. It is not about questioning the necessity of helping territories in difficulty, but about reminding that a public policy, however generous on paper, only proves its value by reaching its target. The question now is whether public authorities will manage to translate this finding into real methodological change, or whether the same pitfalls will continue to feed, year after year, the same impression of quiet waste.
