REVUE D'ÉCONOMIE RÉGIONALE ET URBAINE (5/2022)
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Des disparités territoriales de répartition des infirmières libérales subsistent en France, malgré une progression constante de leurs effectifs. Afin de les réduire, les pouvoirs publics ont mis en place un zonage servant de cadre d’application à des incitations financières dans les zones déficitaires ou pour limiter les installations dans celles sur-dotées. A travers l’étude de l’évolution d’indicateurs relatifs à l’offre de soins dispensés par les infirmières libérales et d’une analyse d’impact, nous montrons dans cet article une amélioration globale de l’accessibilité et une réduction des inégalités territoriales entre 2006 et 2016. Nos analyses permettent de conclure à un impact positif, bien qu’à nuancer, de ces dispositifs et la nécessité de mesures complémentaires pour attirer davantage d’infirmières libérales dans les zones déficitaires.
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.