Le renoncement aux soins : une approche socio-anthropologique

Although the concept of healthcare renunciation is regularly employed in health surveys and increasingly called into the French public debate, it has never been subject to methodological questioning to analyse the term’s underlying significations. If health surveys frequently refer to healthcare renunciation for economic reasons, a socio-anthropological approach using in-depth interviewing permits a broader analysis of its signification for the individuals concerned and establishes the social, economic and cultural determinants involved. This study shows that there are two main forms of healthcare renunciation : barrier-renunciation and refusal-renunciation. In the first case, individuals are confronted with an environment of constraints, more notably budgetary constraints, preventing access to the desired care. The second case is an expression of patient autonomy with regard to conventional medicine. It is characterized by the refusal of certain specific therapies or a more radical, definitive form of refusal when seeking treatment is perceived as being unnecessary. These two forms of healthcare renunciation (barrier and refusal) are often interrelated : the economic factor is rarely isolated and is frequently combined with other reasons leading individuals to forego treatment. An econometric analysis, based on the results of a survey on healthcare renunciation for economic reasons, is being published simultaneously (Després et al., 2011).