L’impact du zonage conventionnel sur la répartition territoriale des infirmières et infirmiers libéraux en France

Self-employed nurses play a significant role in the French health care system. This is especially true in a context of increasing care?s need due to population growth and ageing because they are the key providers in home-based and dependency care. However, in 2021, we still observe territorial disparities in the distribution of self-employed nurses in France, despite a constant increase in their numbers in the last few years. The public authorities have set up a licensure to practice installation regulation since 2012 in order to reduce these disparities. It aims to be used as a framework for applying financial incentives in areas with a shortage of nurses or for limiting their number in areas with an excess of nurses. Using a quasi-experimental analysis framework, based on exact matches between intervention and control areas and difference-in-difference estimation methods, we study the evolution of indicators relating to the supply of care provided by self-employed nurses and the impact of this conventional zoning and associated measures. We show in this article an overall improvement in accessibility and a reduction in territorial inequalities between 2006 and 2016. Indeed, care?s supply provided by nurses has increase in underserved areas while the growth has been slower or even negative in overserved spaces. Our analyses allow us to conclude that these measures have a positive impact. However, additional measures concerning the installation?s determinants are needed to attract more self-employed nurses to areas with a shortage of nurses and in order to improve accessibility to health primary care.