Series: 'Medical desertification and care wandering' — Article 1/5
France is entering an unprecedented zone of healthcare tension. The explosion of chronic diseases, population ageing, a durably declining medical workforce, and persistent fragmentation of care pathways leave the system structurally unable to guarantee continuity of care for those who need it most. The recent PLFSS budget, voted on a minimal basis, reveals the absence of public policy commensurate with the challenge posed by chronicity.
André is 74. Metabolic syndrome, type 2 diabetes, hypertension, early renal insufficiency. He lives in the Tarentaise valley in the French Alps. His GP retires. The practice is taken over by young practitioners attracted by ski trauma medicine: simple, short, well-reimbursed acts with no longitudinal commitment. André requires six specialists, frequent therapeutic adjustments, continuous monitoring. In a system structured around one-off encounters, this type of patient becomes too time-consuming, too demanding, too risky, and insufficiently remunerative.
Ski trauma consultation (tourist): €25 for 15 minutes. André’s follow-up (multi-morbidity): €25 for 45 minutes plus coordination with six specialists. The system does not produce cynical physicians: it creates incentives that make it irrational to properly care for those who need it most.
Care wandering — the patient consults in cascading fashion without coherence, lacking a diagnostic pilot — and medical desertification — a complete break in follow-up, no referring physician, no trajectory — are neither accidental nor due to individual ill will. They are mechanical, systemic, and predictable. The common thread: a system designed to manage isolated acts, not life trajectories that ultimately merge with care pathways. The patient becomes the sole interface between specialists, structures and care episodes — a role beyond their capacity.
André does not disappear by bad luck: he disappears because the system was never designed for him. He falls into a dead zone — the period of silent deterioration between emergency hospitalisations — where most clinical destabilisations are prepared. Nobody monitors his trajectory, nobody detects the weak signals, nobody sees the progressive degradation coming that will lead, one morning, to the emergency hospitalisation that could and should have been avoided. This is not a lack of medical goodwill. It is an emergent property of a system that was never designed to continuously orchestrate patient-centred care pathways.
Access to care: the system is gridlocked, having reached the limits of an architecture designed in 1945 for a different demographic and epidemiological reality. Financial sustainability: patches are applied to a wooden leg, for lack of daring to rethink the architecture and philosophy of the care system — shifting from acute medicine to preventive medicine. The relevant question is no longer “how to add more physicians or more budget” but: what would need to be added to the system so that no patient falls, like André, into this dead zone? Article originally published on LinkedIn (in French).