Medical deserts in the European Union: the practicalities of universal health coverage


Stella Kyriakides, European Commissioner for Health. Co-operators: Photographer: Aurore Martignoni European Union, 2019 Source: EC – Audiovisual Service.

This article was exclusively written for The European Sting by Ms. Cristina Doran, a 6th year medical student from Bucharest, Romania. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Healthcare policies in most European countries aim to ensure universal coverage for all citizens, dispensed fairly and generally covered to a large extent by means of a national insurance system. While the quality of services provided in top urban facilities is continuously improving, keeping pace with current advancements in human knowledge and the development of new technologies, a significant proportion of European citizens are left struggling in remote rural areas, where medical professionals, let alone cutting edge treatment options, are few and far between.

The issue is by no means a new one, although the term “medical deserts” – ‘déserts médicaux’ in the original French – came into widespread use during the past decade; it describes geographical areas where healthcare providers and general practitioners are severely lacking compared to the national average.

For instance, while the healthcare system of France is ranked 20th globally, almost 8% of its citizens (5.3 million people) live in areas with poor access to health professionals, all in the context of a rapidly ageing population, with growing medical needs. Despite the recent increase in the cap on doctors graduating every year (numerus clausus), the situation shows little improvement, as new graduates generally prefer to practice in more narrowly specialised fields and live in larger, dynamic urban centres, which offer more flexible schedules and a better work-life balance in the long term.

Attempts have been made to remedy the situation and to discover novel ways of covering the deficit. In the German state of Hesse, a “medibus” has been set up as a means of compensating for the 170 unfilled doctor’s posts; it consists of a complete mobile GP practice visiting 6 doctor-less villages in Western Germany per week.

However, this required an exemption from the existing ban on itinerant doctors, made in recognition of a lack of viable options. In the French town of Laval, which has the lowest number of practicing doctors per capita (255/100.000 inhabitants, against a national average of 437 and a record 1.100 in Paris), a group of senior and retired physicians have returned to practice in the Service Médical de Proximité (SMP).

Alternatively, tele-medicine remains a solution in areas which have the advantage of reliable broadband connection, although the absence of direct contact between doctor and patient poses a number of practical difficulties and may lead to diagnostic errors.

Most importantly, the shortage of doctors in rural areas has long-term disadvantages. Inadequate prevention and primary care is correlated with increased alcohol, tobacco and drug use, which in turn results in increasing rates of chronic diseases and lower overall life expectancy compared to the average city dweller.

Moreover, the shortage of medical specialists, such as OB/GYN doctors or mental health professionals, has additional detrimental effects, leading to a marked decrease in the quality of life of those affected, who may end up feeling very much left behind by a system that theoretically ensures equal, universally available healthcare.

About the author

Cristina Doran is a 6th year medical student from Bucharest, Romania. She is interested in exploring the connections between human rights theory and the field of medicine, particularly with regard to equal access and the fair distribution of resources. Excited about the potential of new scientific discoveries to educate the minds and improve the lives of a wider audience, as well as their applications in changing the standards of health care for years to come. Passionate about medical education and understanding the ideas and influences that are shaping the minds of future generations.

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