Risk factors and outcomes of not having a preferred doctor: a cross-sectional study based on data from the French main health insurance scheme.

BACKGROUND

In France, 90.1% of the population was registered with a preferred doctor in 2019.

OBJECTIVES

To explore the risk factors and healthcare utilization associated with not being registered with a preferred doctor.

DESIGN AND

SETTING

Population-based cross-sectional study conducted among insured individuals aged 16 years or above in the Lyon metropolitan area.

METHODS

Data was extracted from the French health insurance information system for the year 2019. Univariate and multivariate models were used to analyse the risk factors and healthcare utilization associated with not being registered with a preferred doctor.

RESULTS

Among 878 030 individuals, 12.2% were not registered with a preferred doctor. In multivariate analysis, individuals not registered with a preferred doctor were younger (OR up to 18.2 between 16 and 30 years, compared to those aged ≥ 75 years), more often male (OR = 1.13), lived more often in a high medical accessibility area (OR up to 1.13 in the fourth quartile, compared to the first quartile), had less often a low income (OR = 0.64) or a long-term condition status (OR = 0.30), than those registered. Individuals without a preferred doctor had fewer visits to a GP (OR = 0.09), to a specialist (OR = 0.15), and to an emergency department (OR = 0.35), fewer hospitalizations (OR for no hospitalization = 4.54), and fewer selected prevention procedures (OR as low as 0.06 for breast cancer screening).

CONCLUSIONS

Not having a preferred doctor may limit access to primary and secondary care. Strategies to enhance registration should be considered, particularly for individuals with a long-term condition and those living in medically underserved areas.