When proportionate universalism becomes relative: Access to care of self-employed persons

Abstract

The policy designed to address social inequalities in health (SIH) currently does not integrate the specificities of self-employed persons, who nevertheless occupy an intermediate position in the mortality gradient observed since the 1990s. Qualitative analysis of the care pathway of precarious people, financed by the French Directorate of health care services (DGOS), despite its limitations, highlights the difficulties encountered by self-employed persons in the use of the health system in its present state and shows the poor perception of these difficulties, due to the limitations of the available evaluation tools of individual precarity, the representations of professional and institutional actors, or the absence of response in the field of social solidarity. Supported by documentary analysis, these observations question the meaning of the concept of equity in terms of social protection measures for this socioeconomic category, the proportionate universalism of the measures taken, and suggest new approaches to globally and more effectively address SIH.