Reduce financial barriers to accessing care.

Summary In France, the principle of horizontal equity in access to care is at the heart of the 1945 pact, according to the maxim "From each according to his means, to each according to his needs". However, since its creation, the health insurance system has left part of the cost of care to be paid by patients, in order to make them more responsible. However, these instruments constitute financial barriers to access to care, which are all sources of social inequalities in the use of care. In order to improve equity in financial access to care, various policies have been implemented over the last decades. This article proposes to draw lessons from them and to review the knowledge on inequalities in the use of health care in France. Most of these policies have consisted in introducing free access to certain types of care or in reducing the cost of supplementary health insurance for the poorest households. The available evaluations demonstrate the effectiveness of free care, whether it applies to care or to insurance, even if it can lead to a lower perceived quality or to discrimination when it is accompanied by capped tariffs. The literature also converges on the inefficiency of insurance subsidies. The most recent reforms, which have not yet been evaluated, aim to moderate the prices of care poorly covered by health insurance. Despite these measures, inequalities in the use of health care remain, given a given need for care, and are particularly significant for specialist care, dental and optical care, and preventive care. Reducing financial barriers is therefore a necessary but not sufficient condition for achieving health equity.