🔍💡 Refusal of care: when administrative complexity, medical shortages, and discriminatory biases exclude the most vulnerable from access to care. To equip your teams to face these situations.🧭⚖️ Social, medico-social, health field: 161 testimonies, national data, and concrete recommendations to identify, document, and contest care refusals affecting your audiences.
📌 This document is directly useful tosocial workers, health mediators, health professionals, CPTS/DAC coordinators, faced with care refusals for vulnerable populations (AME, CSS, exile, homelessness, disability, poverty).
It providesrecent statistical data (Oct. 2025–Mar. 2026), examples of situations, andoperational recommendationsaddressed to public authorities, support workers, and caregivers.
It can be used todocument a local diagnosis, support advocacy, train teams, and structure procedures for identifying and reporting care refusals.
Source: 📒 📒 Analysis from the Observatory of Care Refusals / HEALTH IS A RIGHT, NOT A PRIVILEGE
📜🔗LINK
Number of pages: 13
1. Analytical summary
1.1. Context, audiences, and issues
TheObservatory of Refusals of Careof the FAS, created in2016and updated in2025, collects testimonies from individuals and professionals confronted with refusals of care affecting vulnerable populations (AME, CSS, PUMa, exile, homelessness, disability, poverty).
This first report presents161 testimoniescollected between13 October 2025and16 March 2026, of which92% come from professionalsfrom health, social and medico-social structures (hospitals, LHSS, ACT, CHRS, CADA, etc.).
The data shows a widespread phenomenonacross the entire territory, mainland and La Réunion, affecting urban and rural areas, with apredominance of refusals concerning doctors(general practitioners and specialists).
Refusals often take the form ofadministrative filtering, ofpoor reception, ofrefusal of third-party payment, ofnon-use of interpretation servicesor ofbias related to social coverage, origin, language, exacerbated by thelow medical demographicsalready identified by the DREES as a major factor in renouncing care.
The documented consequences range from thecomplexification of pathwaysand therenunciation of careto theworsening of health statusand to thedeferral to emergency services, exacerbating health inequalities and the saturation of the system.
1.2. Operational contributions and levers for action
The report provides adetailed typology of forms of refusal of care(refusal of appointments, refusal to waive upfront costs, refusal of interpretation, abusive referrals, exceeding fees, lack of treatment adaptation to the living context, etc.), useful for identifying and qualifying situations on the ground.
It clarifies thereasons for refusal defined by Health Insurance(CSS/AME coverage, inability to express oneself in French, socio-economic situation, real or presumed origin, disability, loss of autonomy) and allows local actors to situate their observations within a legal and ethical framework.
The recommendations are structured intothree targets: public authorities, professionals supporting individuals, health professionals, with concrete proposals (simplification of rights, interpretation fee coding, health mediation, systematic reporting, integration into PRS/PRAPS, training on social determinants of health and discrimination).
The Observatory is presented as atool for visibility and advocacy, complementary to institutional referrals, allowing for the documentation of a largely under-reported phenomenon and feeding into regional policies (PRS, PRAPS) and coordination actions (CPTS, DAC).
2. Key points of the document
A national collection of 161 testimonies in 6 months
The report is based on161 testimoniescollected between October 2025 and March 2026, of which92% are from professionalsin the field of health, social and medico-social structures (hospital, LHSS, ACT, CHRS, CADA…).
This foundation lays the groundwork for arecurring observation system, with annual publication of analyses in April. (p.3‑5)
A systemic phenomenon, present across the entire territory
Thegeographical distribution of testimonies(mainland and La Réunion) shows that refusals of care are not localized butsystemic, affecting urban departments (Ille-et-Vilaine, Rhône, Nord, Loire-Atlantique) as well as rural ones (Isère, Oise, Morbihan).
The document highlights themobilisation of local associative networksthat integrate the Observatory into their practices. (p.4)
A predominance of doctors and city care in refusals
61% of refusals of care involve general practitioners or specialists, with a strong involvement ofprivate practices and hospital services(emergency, psychiatry, general hospital), while multi-professional structures and health centres are cited less frequently.
Dentistsalso appear in the category "Other", reflecting a build-up of obstacles for the most vulnerable populations. (p.5) apparaissent aussi dans la catégorie « Autre », traduisant une accumulation d’obstacles pour les publics les plus vulnérables. (p.5)
A series of administrative, linguistic and economic barriers
Refusals are expressed throughadministrative filtering(inability to obtain an appointment, 63 mentions), apoor reception in consultations(38), therefusal of third-party payment(24), therefusal of interpretation services(32) and alack of adaptation to life constraints.
The most cited reasons are related tosocial coverage (CSS, AME)(66 mentions), to thelanguage barrier(40) and to theorigin or name(24), which aligns with the work of the DREES on the renunciation of care by poor individuals in under-resourced areas. (p.6‑8, 10‑11, 14‑15)
Severe consequences: renunciation, deterioration, referral to emergency services
The main identified effects are thecomplexification of pathways(69 mentions), therenunciation of care(59), thedeterioration of health status(51) and thereferral to emergency services(27), with concrete examples (avoidable hospitalisations, late diagnosed tumours, etc.).
The low engagement with institutions(CPAM, Defender of Rights, professional orders) reinforces the usefulness of the Observatory to make these situations visible. (p.9‑10, 18‑19) (CPAM, Défenseur des droits, ordres professionnels) renforce l’utilité de l’Observatoire pour rendre visibles ces situations. (p.9‑10, 18‑19)
3. Action points for local stakeholders
Integrate the systematic identification of refusals of care into reception and support practices
Formalise, in each structure (CHRS, CADA, LHSS, CSAPA, day centres, CMP…), theprocedures for identifying refusals of care: systematic questions in interviews, traceability in the social or medico-social file, collective analysis in team meetings. (p.6‑8, 14‑18)
Rely on thetypology of manifestations of refusal(refusal of appointments, filters at the secretariat, refusal of third-party payment, abusive referrals, refusal of interpretation, etc.) to build identification grids. (p.6‑7)
Use the Observatory and institutional referrals as complementary levers
Encourage teams tosystematically feed the Observatory of refusals of careto document local situations and contribute to national analyses, while maintaining thereferrals to CPAM, orders, Defender of Rights, ARSwhen the legal criteria are met. (p.3, 18‑19, 20‑21)
Establish, at the territorial level (CPTS, DAC, associative collectives),times for sharing experiencesaround reported situations in order to evolve local practices.
Strengthen health mediation and partnerships with care structures
Develop or consolidatehealth mediation positions, includingpeer mediation, to support individuals in their processes, clarify their rights, support interactions with healthcare providers, and promote the use of professional interpreting. (p.6‑7, 11, 20‑21)
Formaliselocal agreementsbetween social/medico-social structures and healthcare professionals (private practices, health centres, hospitals) regarding the reception of individuals with complex rights (AME, CSS, PUMa, without a Vitale card).
Record refusals of care in territorial diagnostics and PRAPS/PRS
Use data from the Observatory and field experiences toinform territorial health diagnostics, local health contractsand thePRAPSled by the ARS, in order to recognise refusals of care as a public health issue. (p.11, 20‑21) portés par les ARS, afin de faire reconnaître les refus de soins comme un enjeu de santé publique. (p.11, 20‑21)
Advocate for PRAPS and PRS to explicitly integrate data from the Observatories, CNAM, the Defender of Rights, Médecins du Monde, ComedePRAPS et PRS intègrent explicitement les données des Observatoires, de la CNAM, du Défenseur des droits, de Médecins du Monde, du Comede, etc., as recommended by the report. (p.11)
Train professionals on the social determinants of health, discrimination, and health literacy
Deployinitial and ongoing training sessionson precariousness, discrimination, unconscious biases, interculturality, and health literacy, in connection with universities, professional orders, ARS, and federations. (p.8, 11, 14‑15)
Integrate the contents of the report intointernal training modules(analysis of situations, role-playing, construction of inclusive welcome charters and appeal protocols). (p.11)
4. Additional references
🔍➕ For more information, see the articles referenced by "Practices in Health" on the theme of access to care ➡️🔗https://pratiquesensante.odoo.com/7-1-acces-et-organisation
Federation of Solidarity Actors – "Advocacy I Health of Exiled Persons" (2025) -Advocacy document focused on access to health for exiled persons, including a focus on refusals of care, interpretation, health coverage, and the relaunch of the Observatory in 2025.
France Assos Santé – "Survey on Discriminatory Refusals of Care in Auvergne-Rhône-Alpes towards People in Situations of Precarity" (2025)
Recent regional survey on discriminatory refusals of care, methodologically and thematically complementary (identification, typology, regional recommendations). - https://france-assos-sante.org/etude/enquete-sur-les-refus-de-soins-discriminatoires-en-auvergne-rhone-alpes-envers-les-personnes-en-situation-de-precarite
5. Cross-sectional analysis — Values of Practices in Health
Literacy: The document clarifies the systems (PUMa, CSS, AME) and possible appeals, but it is primarily aimed atprofessionals, with few tools directly adapted for audiences with low literacy. (p.3, 11, 18-19)
Empowerment: Beneficiaries appear little as advocacy actors, but the Observatory allows for theobjectification of their experiencesto transform practices and public policies. (p.3, 18-21)
Participation: Participation is mediated by theprofessionals who testify(92% of responses), the report does not present co-construction mechanisms with the people concerned. (p.3-5)
Community health: The collective dimension is present through themobilisation of associative networks, health mediation, regional collectives and CPTS/DAC, but the concept is not explicitly formulated. (p.4-5, 11, 20-21)
Ethics: The report questions thebiases of social coverage, origin, language, socio-economic situation, but does not develop a structured ethical analysis (principles, values, frameworks). (p.6-8, 14-15)
Human rights: It clearly states that"health is a right, not a privilege"and is part of an approach ofequity and non-discrimination, in line with fundamental rights to health. (p.1, 3, 11, 14-15)
Intersectorality: The document emphasises thecooperation between social, medico-social, health sectors and national/regional institutions (DGS, CNAM, ARS, CPAM, Defender of Rights, Doctors of the World, Comede, etc.). (p.3, 11, 20-21)
Partnership: It promotes formalisedcollaboration modelsthrough CPTS, DAC, PRAPS and regional health projects, but without detailing standard protocols or agreements. (p.11, 20-21)
Fight against discrimination: Discrimination related tohealth coverage, origin, language, disability, socio-economic situationare explicitly mentioned, with a call fortraining on unconscious biases and interculturality. (p.6‑8, 14‑15)
6. Assessment of the reliability of the resource
Scientific relevance
Recent data (2025‑2026), based on a systematic collection via the Observatory relaunched in October 2025.
Methodology explicitly limited to a6-month deployment phase, with caution regarding territorial representativeness, but consistent with other sources (DREES 2021, FAS/France Assos surveys).
External references used (DREES) comply with public statistics standards.
The declarative nature of the testimonies implies aselection bias, clearly acknowledged, but the convergence with other works strengthens the robustness of the finding.
Operational relevance
Very high: detailed typology of forms of refusal, reasons, consequences, complemented bytargeted recommendationsfor public authorities, support workers, and caregivers. (p.6‑11, 20‑21)
The Observatory tool is directly usable by the structures, and the action pathways are transposable intohealth projects, territorial diagnostics, training, and internal procedures.
7. MCQ — 5 questions
Part 1 — Questions (without answers)
Question 1 (p.3‑5)
Between which dates were the testimonies analysed in this report collected?
a) From 1 January 2025 to 31 December 2025
b) From 13 October 2025 to 16 March 2026
c) From 7 April 2024 to 7 April 2025
d) From 1 June 2023 to 31 December 2024
Question 2 (p.3‑5)
What percentage of testimonies comes from field professionals?
a) 52%
b) 61%
c) 92%
d) 100%
Question 3 (p.5‑8)
According to the report, which type of structure is most often associated with reported refusals of care?
a) Multi-professional health houses
b) Private practices and hospital services
c) Municipal health centres
d) Vaccination centres
Question 4 (p.6‑7, 14‑15)
Among the following elements, which is cited as one of the main reasons for refusals of care?
a) Place of residence in an urban area
b) Social coverage (CSS, AME)
c) Membership in a patient association
d) Refusal to sign informed consent
Question 5 (p.9‑10, 18‑19)
Which of these consequences is identified as a major repercussion of refusals of care?
a) A decrease in emergency visits
b) A reduction in the number of specialised consultations
c) Strengthening of individuals' social networks
d) Deterioration of health and renunciation of care
Part 2 — Commented correction
Question 1: Between which dates were the testimonies analysed in this report collected?
✅ Correct answer: b) From 13 October 2025 to 16 March 2026
📝 Explanation: The report specifies that the data comes from testimonies collected between therelaunch of the Observatory on 13 October 2025and thefirst data extraction on 16 March 2026, a deployment period of six months. Source: p.3.
Question 2: What percentage of the testimonies comes from field professionals?
✅ Correct answer: c) 92%
📝 Explanation: Among the 161 testimonies,92%were submitted by professionals (nurses, specialised educators, doctors, health mediators) from health, social and medico-social structures. Source: p.3-5.
Question 3: What type of structure is most often associated with reported refusals of care?
✅ Correct answer: b) Private practices and hospital services
📝 Explanation: Refusals of care are concentrated in the"classic" modes of practice: private practices (doctors, dentists, paramedics) andhospital services(emergency, psychiatry, general hospital), while multi-professional structures and health centres are mentioned less frequently. Source: p.5.
Question 4: Which is cited as one of the main reasons for refusals of care?
✅ Correct answer: b) Social coverage (CSS, AME)
📝 Explanation: The report highlights that refusals of care are often linked totypes of health coverage, particularly the Complementary Health Solidarity (CSS) and the State Medical Aid (AME), with 66 mentions, making it one of the main reasons identified by respondents. Source: p.8, 14-15.
Question 5: Which of these consequences is identified as a major repercussion of refusals of care?
✅ Correct answer: d) Deterioration of health and renunciation of care
📝 Explanation: Refusals of care lead to acomplexification of pathways, arenunciation of care(59 mentions) and adeterioration of health(51 mentions), associated with deferrals to emergency services. The report documents several concrete examples illustrating these effects. Source: p.9-10, 16-19.
8. Frequently Asked Questions (FAQ)
What is the main objective of the Observatory of Refusals of Care?
The Observatory aims toqualify and quantify the difficulties of access to carerelated to refusals of care, relying on testimonies from affected individuals and professionals, tofeed the dialogue with institutionsand formulate recommendations. (p.3)
Who can submit a testimony to the Observatory?
The report shows thatfield professionalsare the majority among respondents (92%), but the tool is also designed to collecttestimonies from affected individuals., in a logic of a simple and confidential platform. (p.3‑5)
How do refusals of care most often manifest?
They manifest notably throughrefusals to make appointments, apoor reception in consultations, refusals of advance payment waivers, refusals to use interpretation services, or repeated and abusivereferrals to other facilities. (p.6‑7) ou encore des orientations répétées et abusives vers d’autres structures. (p.6‑7)
What reasons for refusal are considered discriminatory under the law?
The following are cited as reasons for refusal: social coverage (CSS, AME), real or presumed origin, theability to express oneself in French, socio-economicsituation, disabilityand loss of autonomy, when these reasons are not justified by a relevant medical reason. (p.8, 14‑15)handicap et la perte d’autonomie, lorsque ces motifs ne sont pas justifiés par une raison médicale pertinente. (p.8, 14‑15)
What are the main consequences of refusals of care for individuals?
Refusals of care lead to acomplexification of pathways, postponements of appointments, arenunciation of care, anaggravation of health statusand areferral to emergency services.report vers les services d’urgences, with major impacts on people's health and the burden on the system. (p.9‑10, 16‑19)
Why are refusals of care rarely reported to institutions (CPAM, orders, Defender of Rights)?
The report highlights alow recourse to instances, due to thelack of time, thefear of repercussionsand thecomplexity of procedures, which justifies the existence of the Observatory as a complementary reporting space. (p.10, 18‑19)
What concrete recommendations are made for public authorities and professionals?
The document proposes tosimplify the opening and maintenance of rights, torate health interpreting, todeploy health mediation, tosystematise reporting, toraise awareness among supported individuals about their rights, tointegrate the specificities of vulnerable populations into PRS/PRAPS, and totrain professionals on the social determinants of health and discrimination. (p.11, 20‑21)
9. Rewriting in Easy-to-Read Language
9.1. Easy-to-Read Summary – Context and Issues
Purpose of the document
This document discussesrefusals of care.
A refusal of care is when a personcannot receive carewhen she needs it.
Who is concerned?
Peoplewithout much money.
People with rights such asCSS, AME, PUMa.
Peopleexiled or without stable housing.
Where does the information come from?
The information comes from161 stories told.
These stories were collected betweenOctober 2025 and March 2026.
Almost all come fromfield professionals.
Where do refusals of care happen?
Refusals happenthroughout France, in cities and in the countryside.
They often occur withdoctorsand at thehospital.
What causes?
Complicatedpaperworkfor rights.
Languageproblems.
Prejudicesabout people's origin or poverty. sur l’origine ou la pauvreté des personnes.
What are the consequences?
Peoplewait longerfor care.
Somegive up and no longer seek treatment.
Health conditionsworsenand theemergency services are overwhelmed.
9.2. FALC Summary – Operational Contributions
The documentexplains the different types of refusals.
He gives someexamples of real situations.
He proposes somesolutions for public authorities.
He also proposes someactions for field professionals.
The Observatory helps tomake these problems visible.
It serves tochange local practices and laws.
9.3. Key points FALC
Point 1: Many recent testimonies
161 stories of refusals of care.
Recent stories, over 6 months.
Mainly professionals who testify.
Point 2: A problem everywhere in France
Refusals in cities and in the countryside.
Refusals also in the overseas departments, like Réunion.
Point 3: Doctors often involved
Many refusals come from doctors' offices.
Some hospital services also refuse.
Point 4: Administrative and linguistic barriers
Difficulties with CSS and AME.
Problems with the French language.
Interpreter not always accepted.
Point 5: Serious effects on health
Delayed care.
People who give up on care.
Worsening illnesses.
More visits to emergency services.