Health. Are we all treated equally? Not really, says the Defender of Rights.

Women, people of foreign origin, people with disabilities... according to a report by the Defender of Rights published Tuesday, not everyone receives equal care, and some face discrimination in their access to care and throughout their medical journey. "While refusal of access to care remains the most well-known and obvious form, discrimination can occur at all stages of care and, in a less visible or conscious way, within the caregiver-patient relationship," said the independent authority responsible for ensuring respect for rights in France.

In 2022, 224 complaints were filed with professional bodies and the Health Insurance Fund, and 31 complaints were sent to the Defender of Rights, Claire Hédon , but the "scale of discrimination far exceeds" these figures, the report states. In theory, health professionals do not have the right to refuse a patient unless the request for care does not correspond to their area of ​​expertise, if they have too many patients, or if the patient in question has already been violent or insulting towards them.

But in practice and on the ground, this rule is subject to numerous breaches, whether in access to care or in the care pathway, notes the Defender of Rights. In emergency services, the independent authority describes "an underestimation" of pain and "the severity of symptoms expressed by women, particularly when they are young, of foreign origin, or perceived as such."

"Depending on the case, the patient's pain is either minimized or questioned and attributed to supposed anxiety or hidden psychological suffering," she denounces. "The 'Mediterranean syndrome,' a racist prejudice without medical basis according to which people of North African or Black origin exaggerate their symptoms or pain," has "the effect of minimizing the suffering expressed" by these patients "and/or refusing treatment, with sometimes fatal consequences."

Other victims of this discrimination are economically vulnerable people, such as patients living on the streets or drug users who, "because of their physical appearance, body odor or alcohol consumption," may be refused access to emergency services.

Beneficiaries of universal health coverage (CMU), complementary health insurance (CSS), and state medical aid (AME) are having difficulty getting even an appointment, according to the report. As for people with disabilities, some are being refused for reasons ranging from "lack of time or training" to "inaccessible premises or unsuitable medical equipment."

Beyond access to care, the Defender of Rights is concerned about "frequent violations" of the patient's right to receive useful information to make an informed choice and to be able to give consent. This is particularly the case for women during their gynecological follow-up with examinations (smear tests, endovaginal ultrasounds, IUD insertion) "carried out without prior information and without their consent being sought."

But the institution also says it has been alerted about "unconsensual acts of care on people with mental disabilities", such as the forced administration of an injection to a patient who was being treated under the voluntary hospitalization regime, or the increased and unjustified use of force, restraint or isolation.

These discriminations have "immediate and lasting harmful consequences on the care pathway of patients," who end up postponing or completely forgoing care, warns the institution, which urges the government to implement a national strategy to prevent and combat these practices. It recommends, in particular, focusing efforts on preventing such discrimination, collecting and processing reports, and adapting the healthcare system to the specific needs of certain patients.

"We're seeing that there are very few appeals and very few sanctions, so we need to train doctors," but also "the governing bodies" of the various health professions, Claire Hédon said on franceinfo on Tuesday. "And I think that at some point, we need to introduce sanctions that are sufficiently dissuasive."