Risk factors and outcomes of not having a preferred doctor: a cross-sectional study based on data from the French main health insurance scheme.

Background: In France, 90.1% of the population was registered with a preferred doctor in 2019.

Objectives: To explore the risk factors and healthcare utilization associated with not being registered with a preferred doctor.

Design and setting: Population-based cross-sectional study conducted among insured individuals aged 16 years or above in the Lyon metropolitan area.

Methods: Data was extracted from the French health insurance information system for the year 2019. Univariate and multivariate models were used to analyse the risk factors and healthcare utilization associated with not being registered with a preferred doctor.

Results: Among 878 030 individuals, 12.2% were not registered with a preferred doctor. In multivariate analysis, individuals not registered with a preferred doctor were younger (OR up to 18.2 between 16 and 30 years, compared to those aged ≥ 75 years), more often male (OR = 1.13), lived more often in a high medical accessibility area (OR up to 1.13 in the fourth quartile, compared to the first quartile), had less often a low income (OR = 0.64) or a long-term condition status (OR = 0.30), than those registered. Individuals without a preferred doctor had fewer visits to a GP (OR = 0.09), to a specialist (OR = 0.15), and to an emergency department (OR = 0.35), fewer hospitalizations (OR for no hospitalization = 4.54), and fewer selected prevention procedures (OR as low as 0.06 for breast cancer screening).

Conclusions: Not having a preferred doctor may limit access to primary and secondary care. Strategies to enhance registration should be considered, particularly for individuals with a long-term condition and those living in medically underserved areas.