Socio-spatial inequalities in presence of primary care physicians and patients' ability to register: A simulated-patient survey in the Paris Region.

Objectives: We studied the socio-spatial inequalities of three types of general practitioner (GP) density in the Paris metropolitan area: the density of GPs present (that is, practising) in the census block and of those registering new patients for office visits and, separately, for house calls.

Study Design: An exhaustive simulated patient survey enabled us to determine the number of GPs practising in the Paris metropolitan region accepting new patient registration for continuing care at their office and/or for house calls.

Methods: We measured at the level of a census block three types of GP densities: density of GPs present, density of GPs registering new patients at their office and density of GP registering new patients for house calls. We compared the association between the social deprivation level and each density measurement overall, then by stratifying for the population density of the census block.

Results: In 2017-2018, we contacted 8171 physicians (87.6 % of the GPs in the region). Although more than 55 % of Ile-de-France census blocks had (at least) one practising GP, fewer than 40 % had one willing to register a new patient for ongoing office care, and fewer than 20 % for home care. Regardless of the GP density considered, it decreased as the census block's deprivation index rose. However, these inequalities were more marked for registration than for presence and in the most densely populated blocks.

Conclusions: In conclusion, the indicators of GPs' mere presence appear to minimise the socio-spatial disparities associated with access to registration.