Lost in transformation: comparative analysis of healthcare provision dynamics within urban systems of European Russia and France

Since the 1990s, many countries have implemented healthcare reforms underlined by New Public Management principles and technological transformations. Although studies have examined these reforms from different viewpoints, the spatial implications of healthcare reforms have received limited attention. Scholarship focused predominantly on regional variations of healthcare provision overlooking the sharp contrasts between cities where most healthcare facilities are de facto located. Addressing this research gap, we investigate the long-term dynamics of healthcare provision on the urban level, tracing the differences (if any) between cities of different sizes and administrative statuses. The study adopts a comparative approach. We draw our data from two countries: France and Russia (mainland France and European Russia). Findings indicate that, despite some variations, healthcare reforms in both countries follow similar paths, resulting in fewer hospital beds that have been partially replaced by places in day hospitals. At the same time, we also observe diverging country-specific trends in terms of redistribution of healthcare provision. In France, some cities completely lost their hospital equipment but those cities that remained equipped tend to a uniform distribution. In European Russia, on the contrary, all cities remain equipped but there is a drastic polarization depending on size and administrative status.