Variability of practices and inequalities in access to care in France: the case of cancerology.

Summary This thesis focuses on the question of variability in cancer management practices and on the study of the determinants of social and spatial inequalities in access to care, with a particular focus on cancer patients. In recent years, public authorities have noted strong variability in the rates of recourse to certain types of treatment. The first chapter of this thesis asks the question of the determinants of differences in the use of prostatectomy as a treatment for prostate cancer. The results show a strong positive influence of variables relating to the supply of care, both at the level of the department and the region, and the fight against social inequalities in health is also carried out thanks to mechanisms such as the ALD. The second chapter looks at the determinants of the use of general practitioners and specialists, differentiating between visits to the latter that are related to ALD pathology and those that are not. For visits to general practitioners, the results show that a lower socio-economic status seems to be associated with a higher use of care. Finally, since 2004, an organized breast cancer screening program has been in place for all women aged 50 to 74. The objective of the last chapter is to examine the potential influence of the density of general practitioners and specialists on the rates of recourse to this screening over the period 2005-2012. It appears that a higher density of general practitioners is significantly associated with a higher utilization rate. Conversely, an increase in the density of specialists tends to have a negative impact. The estimates also highlight a spatial effect . medical densities in neighboring departments also have an effect on the use of organized screening.