🔍💡 Refusal of care: a massive phenomenon, documented by over 160 field testimonies, which exacerbates the renunciation of care among vulnerable populations. #RefusalOfCare #AccessToCare
⚖️🩺 Health is a right, not a privilege: this 2026 analysis provides figures, concrete examples, and levers for action to address refusals of care in your areas. #HealthSocialInequalities #FightAgainstDiscrimination
📌 This document directly equips social workers, health mediators, outreach nurses, structure coordinators, and reception associations who face repeated refusals of care for their clients.
It allows for the qualification of situations (types of refusals, profiles of professionals, consequences) and relies on national figures to engage in dialogue with ARS, orders, and establishments. It also provides concrete recommendations for documenting cases, guiding towards recourse, and adapting support practices.
Source: 📒 Analysis of the Observatory of Refusals of Care: Health is a Right, Not a Privilege
✍️ Federation of Solidarity Actors (FAS), national working group Observatory of Refusals of Care
📜🔗LINK to the source
Number of pages: 38
1. Analytical summary
Context and issues: a diffuse, massive, and under-reported refusal of care
The Observatory of Healthcare Refusals, relaunched by the FAS in October 2025, is based on more than 160 testimonies collected mainly from social, medico-social, and health professionals, who report situations experienced by people in extreme precariousness, exiles, without open rights or in complex administrative situations. The data shows that 61% of refusals involve doctors, both general practitioners and specialists, in both private and hospital sectors, and that the phenomenon is neither isolated nor localized but spread across the entire territory, including overseas. Refusals take various forms: failure to make appointments, illegitimate administrative requirements, exceeding fees, refusal to provide treatments or procedures, and lack of adaptation to specific needs. These practices lead to renunciation of care, deterioration of health, inappropriate use of emergency services, increased psychosocial risks, and a breakdown of trust in the healthcare system. They occur within a broader context of tensions in the supply of care, structural discrimination, and complexity of systems (AME, PUMa, CSS...), already documented by other barometers and national reports. Finally, the majority of situations do not result in appeals to the authorities (CPAM, orders, Defender of Rights), which limits the statistical visibility of a phenomenon that is nonetheless described as massive by field actors.
Operational contributions: detailed qualification of situations and levers for action
The document proposes a structured analytical framework that distinguishes types of refusals (direct, indirect, administrative, financial, structural) and levels of impact on pathways, allowing field teams to better document and objectify what they observe. It provides quantitative data (proportions by type of professional, by situation, by consequence) and concrete examples of situations, usable in training, awareness-raising, and advocacy with local and national institutions. The Observatory is based on a standardised questionnaire to be completed by professionals, which can be reused or adapted in structures to systematise case collection and harmonise feedback. The report leads to a series of operational recommendations: better inform the public and support workers about rights, simplify and make appeals effective, strengthen training for health professionals on non-discrimination and reception, and equip territorial networks for managing complex situations. It also highlights the importance of alliances between associations, health establishments, professional orders, and authorities (ARS, Health Insurance, Defender of Rights) to address recurring cases and modify institutional practices. Finally, it positions the Observatory as a living tool, to be regularly updated, to monitor the evolution of the phenomenon and assess the impact of actions taken.
2. Key points of the document
The scale of the phenomenon: over 160 testimonies collected in a few months, of which 92% come from field professionals, showing that the refusal of care is a systemic problem that goes beyond isolated, media-covered cases (p. 6-8).
The central role of doctors: 61% of refusals of care involve general practitioners and specialists, in both the private and hospital sectors, which calls into question the accessibility of primary care and specialised services for the most vulnerable populations (p. 8‑9).
A precise typology of refusals: the report distinguishes between direct refusals (explicit refusal of care), indirect refusals (abnormally late appointments, abusive administrative or financial requirements), structural refusals (lack of adaptation, incompatible reception conditions) and refusals to provide treatments or devices (p. 10‑14).
Major consequences on pathways: refusals lead to renunciation of care, deterioration of health, disorganisation of follow-ups, potential excess mortality and diversion to emergency services, with a marked impact on people in situations of extreme vulnerability, exile, disability or chronic illnesses (p. 16‑19).
Very limited recourse to complaint mechanisms: 65% of professionals report not seeking recourse from the relevant bodies (CPAM, orders, Defender of Rights), due to lack of time, knowledge of procedures or fear of damaging the relationship with care structures, which statistically renders the phenomenon invisible (p. 18‑19, 22‑23).
3. Action points for local actors
Establish a systematic collection of refusals of care within the structure, using or adapting the Observatory's questionnaire (situation typology, professional profile, consequences, follow-up actions), in order to have consolidated data for dialogue with partners (p. 10‑14, methodological annex).
Train and equip teams (social workers, health mediators, nurses, reception staff) on the legal framework of refusal of care, the ethical obligations of health professionals, and the possible appeal procedures (CPAM, orders, Defender of Rights, courts), drawing on examples of situations described in the report (pp. 14-20, 22-24).
Co-construct, at the territorial level, short circuits for resolving situations of refusal of care with health centres, hospitals, professional orders, and Health Insurance (dedicated referents, coordination cells, local agreements), based on the findings of the Observatory to legitimise the approach (pp. 20-24).
Systematically integrate the issue of refusals of care into local health diagnostics, associative projects, CLS, local mental health contracts, and CLSM approaches, using data from the Observatory as advocacy material to better align services with the needs of highly vulnerable populations (pp. 6-8, 20-24).
Develop awareness-raising and education actions on user rights (health rights workshops, collective support, multilingual materials) to strengthen individuals' ability to identify an illegal refusal of care, to request an explanation, and, if necessary, to initiate an appeal with the support of a professional (pp. 16-20, 22-24).
4. Additional References
🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the topic of access to care ➡️🔗https://pratiquesensante.odoo.com/7-1-acces-et-organisationand the fight against inequalities ➡️🔗https://pratiquesensante.odoo.com/2-1-inegalies-sociales-territoriales
Defender of Rights – "Preventing Discrimination in Healthcare Pathways" (2025 report): detailed analysis of health discrimination, including denial of care, avenues for recourse, and recommendations to public authorities. Available online on the AP-HP / Defender of Rights website (verified, accessible in 2026).https://affairesjuridiques.aphp.fr/textes/rapport-du-defenseure-des-droits-prevenir-les-discriminations-dans-le-parcours-de-soins-2025/- The Defender of Rights meticulously documents discrimination in healthcare pathways and calls for a dedicated national strategy, with statistical measurement, patient information, and enhanced training for professionals on equality and non-discrimination.
France Assos Santé & Ipsos BVA – "2026 Barometer of the Rights of Sick People": national quantitative data on difficulties accessing care, refusals, waiting times, and users' knowledge of their rights. Publication in 2026, accessible on the France Assos Santé website (active URLs in 2026).https://www.ipsos.com/fr-fr/acces-aux-soins-delais-refus-penuries-la-sante-des-francais-sous-pression- The France Assos Santé 2026 Barometer shows that, despite better knowledge of rights, a quarter of the French population faces refusals or impossibilities in making appointments, and that excess fees, shortages, and excessive waiting times remain major obstacles, especially for the most vulnerable groups.
FHF & Ipsos BVA – "2026 Barometer of Access to Care" (3rd edition): measurement of care renunciation (73% of the French have renounced care at least once in 5 years) and analysis of territorial inequalities, useful for contextualising the results of the Observatory. Report and summary available on the FHF website (verified in 2026).https://france-assos-sante.org/actualite/inegalites-dacces-et-renoncement-croissants-aux-soins-les-revelations-du-barometre-de-lacces-aux-soins-fhf-2026/- The FHF 2026 Barometer confirms a rapid deterioration: 73% of the French report having renounced at least one care in five years, with waiting times multiplied since 2019 and significant territorial inequalities, which puts pressure on public hospitals and increases reliance on emergency services.
5. Frequently Asked Questions (FAQ)
Who can use the Observatory of Care Refusals on a daily basis?
The Observatory is designed for field professionals: social workers, mediators, nurses, doctors in non-profit organisations, managers of accommodation or day care services, who identify refusals of care for their clients. The questionnaire and analysis grid allow them to document these situations in a consistent manner (p. 6-8, 10-12).
What exactly is meant by a "refusal of care" in this report?
The report defines a refusal of care as any behaviour or decision by a professional or a health structure that unjustifiably prevents, delays, or degrades access to care, whether explicit (direct refusal) or indirect (conditions, delays, unreasonable requirements). This includes refusals related to the social, administrative, financial situation or health status of the person (p. 10-14).
How can indirect refusals of care, which are often difficult to prove, be identified?
Indirect refusals manifest as unusually late appointments compared to usual practices, administrative or financial requirements not stipulated by regulations, discouraging poor reception, or a lack of adaptation of care to needs (p. 10-14). The report provides categories and specific examples to help teams qualify these situations (p. 11-13).
Which groups are most exposed to refusals of care?
The testimonies particularly highlight people in extreme precariousness (housing, street), exiled individuals (with or without open rights), beneficiaries of the AME, CSS or in PUMa, and people living with chronic illnesses or disabilities (p. 6‑8, 14‑16). These groups face a combination of administrative obstacles, stigma, and a lack of awareness of their rights.
What are the main consequences of refusals of care on people's health?
Refusals lead to forgoing care, delays in diagnosis, worsening of conditions, disruption of follow-ups, and more frequent recourse to emergency services for situations that could have been managed earlier (p. 16‑19). They also have effects on mental health, self-esteem, and trust in institutions.
What can organisations concretely do when they observe a refusal of care?
The report recommends documenting the situation (context, statements made, consequences), informing the person of their rights, seeking alternative referrals, and, if necessary, activating appeal bodies (CPAM, orders, Defender of Rights), possibly with support from an associative or institutional network (p. 18‑20, 22‑24). It also encourages the establishment of local partnerships with care structures to prevent the recurrence of these situations (p. 20‑24).
How can the Observatory support advocacy at the local or national level?
By aggregating qualitative and quantitative data from various regions, the Observatory produces numerical elements, typologies, and concrete examples that can be used in diagnostics, territorial projects, and dialogue with public authorities (pp. 6-8, 20-24). This data shows that refusals of care are not isolated incidents but manifestations of structural inequalities in access to health.
6. Rewriting in Easy-to-Read Language
Title
Refusal of Care: Understanding and Acting
Simple Context
Some people are unable to see a doctor or healthcare provider.
They often live on the streets or in very precarious housing.
Some are foreigners or do not have all their documents.
Professionals report these situations in a questionnaire.
These testimonies come from several regions in France.
They show that the problem is frequent and serious.
Simple Issues
Many refusals come from general practitioners or specialists.
Sometimes, the refusal is clear: the doctor says no.
Sometimes, the refusal is hidden: very late appointments, additional paperwork, money requested.
People then abandon their care.
Their health deteriorates over time.
They go to the emergency room more often for serious problems.
Simple Practical Contributions
The document explains how to describe a refusal of care.
It offers categories to classify situations.
Professionals can fill out a questionnaire for each case.
This information is used to communicate with hospitals and doctors.
It is also used to alert institutions that protect rights.
The aim is to change practices and open access to care.
Key points in Easy to Read and Understand Language
Refusal of care is common throughout France.
Doctors are often involved in these refusals.
Poor or foreign individuals are the most affected.
These refusals lead to the abandonment of important care.
The document helps professionals to note and report these refusals.
7. Cross-sectional analysis – Values of Health Practices
Literacy: the document remains written in expert language, but the structuring into typologies, examples, and recommendations allows for a gradual appropriation by professionals of varying training levels; it does not directly offer tools for users with low literacy (p. 6-24).
Empowerment: the analysis is centred on the accounts of professionals recounting situations, and less on the direct participation of beneficiaries; the empowerment of individuals mainly comes through information about their rights and avenues for recourse (p. 14-20).
Participation: the system mobilises a national working group and a network of associations to co-construct the questionnaire and analyse the data, but does not describe formalised mechanisms for co-construction with the affected public (p. 6-8, annex).
Community health: the collective dimension appears through the mobilisation of solidarity structures, territorial reading, and advocacy, but the document remains focused on individual access to care rather than on organised community dynamics (p. 6‑8, 20‑24).
Ethics: the report explicitly identifies discrimination, administrative and financial barriers as violations of equal access, and reminds of the ethical obligations of health professionals without developing a formalised ethical framework (p. 10‑20).
Human rights: the approach aligns with a rights-based perspective (health as a right, prohibition of discrimination, possible recourse), and emphasises equitable access for vulnerable or exiled populations (p. 6‑8, 16‑20).
Intersectorality: the document recommends collaborations between the social, medico-social, health, health insurance sectors, and rights advocacy institutions, highlighting the need for shared circuits for handling refusals (p. 20‑24).
Partnership: it values territorial networks, working groups, and FAS–care structures–institution alliances, while not proposing a formalised model of partnership governance (p. 20‑24).
Combating discrimination: economic, social, administrative, and sometimes health-related discrimination are central to the analysis, and the report makes non-judgment, non-discrimination, and respect for rights an explicit area of action (p. 10‑20).
8. Evaluation of the reliability of the resource
Scientific relevance: the resource is based on a collection of over 160 standardised testimonies, analysed by a working group involving various stakeholders, with transparency regarding the limitations (declarative data, selection bias). The results are consistent with other recent sources (FHF barometers, France Assos Santé, report from the Defender of Rights), which enhances their scientific credibility, even though it is not a strictly epidemiological study (pp. 6-8, 14-20).
Operational relevance: the resource is highly operational for social, medico-social, and community health professionals, as it provides a reusable typology, a questionnaire, examples of situations, and concrete recommendations for data collection, internal training, advocacy, and appeals (pp. 10-24). It allows for a quick transition from informal observation (‘we are being denied care’) to structured argumentation with partners and decision-makers.
H. Points of caution in facilitation
The document addresses a sensitive theme: inequalities in access to care, discrimination, refusal of care for vulnerable populations, exile, disability, or stigmatised conditions (notably HIV).
Risks of emotional triggering:
Reactivation of situations of refusal or humiliation experienced by professionals or individuals being supported (pp. 14-19).
Feelings of powerlessness or anger in the face of repeated discrimination and the absence of effective recourse in certain areas (pp. 18-20).
Compassion fatigue among those who are highly exposed to these situations (social workers, mediators, volunteers).
In animation, it is important to allow time for collective debriefing, to name possible emotions, to remind of available resources (supervision, exchange spaces, support systems) and not to use overly detailed case examples without preparing the group.
#️⃣ #RefusalOfCare #AccessToCare #SocialHealthInequalities #FightAgainstDiscrimination #CommunityHealth #HealthRights #HealthLiteracy @HealthPractices