Contenu du sommaire : Espaces de soins dans les pays développés - Health Care Areas in the developed countries

Health Care Consumption varies from one Region to another? So what? This article is a review of knowledges on variations of health care consumption. It summarizes the main results of research on nature and extent of this phenomenon, on it causes (population characteristics, health care system and providers), and on it potential consequences (medical costs and population health). The implications of these variations for further research and health care politics are discussed.

Physicians in the United States: Equity and Territorial Justice. In the U.S.A., unequal distribution of general practitioners leads to important geographical disparities in the distribution of medical services at all scales (Nations, metropolis, urban areas). What factors are contributing to explain these social and spatial disparities which have not (or virtually not) been obliterated since twenty years? In this liberal economic nation, social and economic characteristics seem to determine practitioners' choices and professional strategies. In urban ares, ethnical and social factors seem to be more determining.

Access to Health Care and Urban Inequalities in France. Differences in the social make-up of towns result in inequalities of health indicators (health status, access to gps). These differences illustrate the impact of spatial structure: urban hierarchy between the inner city and suburbs, social hierarchy between wealthy and poor districts and contrasts between industrial areas and commercial centres. This study was achieved by doing a cluster analysis of 36,000 communes in France.

Health Care and Urban Areas: a Geographical Reading of Sanitary Conditions' Dynamics in Tahiti. During the last 30 years, the Island of Tahiti has experienced a spectacular urban growth in relation with an unprecedented economic development mainly led by the activity of the nuclear testing centre (C.E.P.). The rapidity of changes in the urban areas is a permanent cause of maladjustments between the spatial distribution of men and their activities, health supply and a new distribution of health care consumption which becomes different moreover. Geographical sketch profiles of health data distribution, and their analysis in term of opposition between centres and outskirts reveal multiple contradictions between health supply and demand. More generally, these easily realized geographical sketch-profiles - which can be called spatiograms - seem to be a very efficient way to locate health inequalities.

Catchment Areas of Health Care Amenities: Distance and Medical Consumption. The effect of distance between place of residence and points of health care on the consumption of the latter. Because of resistance to move, patients live closer to the providers of health care than does the general population. A decreasing attraction model is appropriate to various types of care. The effect of distance is greater for the elderly, the self-employed and the rural population of the eastern central part of France. Relations of complementarity and of substitution as well as the difficulty to travel may modify the effect of distance.

This study of the utilizator patterns of child health clinics in four socio-economic study areas in Tasmania provides evidence both that these clinics are equitably placed and that they record even workloads. This result is contrary to that found in other geographical studies and provides grounds for some satisfaction with the State Department of Health.