Accessibilité et organisation des soins de premiers recours

Accessibility to the health system and primary care organization This article is about an analysis of the health inequalities reduction processes and policies, by the analysis of the opportunities opened by health systems to effective rights for the health and the access to healthcare. In France, health insurance policies (CMU-C for example) reduced the financial barriers of health care access but primary care organization has an effect on coordination, globality and continuity of care, on access to the prevention and finally on the reduction of the disparities. The study of primary care organization highlights the role of the formal and informal principles, rules and norms which constitute factors or costs of accessibility. It stresses the contributions of integrated and multi-professional organizations, as centres de santé et Maisons de Santé Pluridisciplinaires. These organizations are an interesting way regarding coordination, continuity and global care and offer various forms of accessibility. Their development is however constraint by their economic model. The evolution of institutional environment is a condition to their development.