De l'inégalité sociale devant la santé au dualisme sanitaire : le RMI, une réponse adéquate aux besoins de santé des plus défavorisés ?

Literature on household medical expenditure according to socio economiccategories indicates that that disparities in access to health care are no longer a major obstacle to social equality. Nevertheless these surveys do not take into account the dualistic structure of society and therefore do not recognise the changing issues in health and social policy. As regards health policy the issues are set in terms of the exclusion of those individuals who since they live on the fringes of economic activity no longer qualify for Social Security benefits. To give a complete picture of social inequalities it is essential to study this exclusion from health care. By studying the people who are on "RMI" (minimum income support) it is possible to survey all the health problems of a growing number of people living on the fringes of economic activity. The poor state of health of people on "RMI" can be explained by less frequent use of health care and unhealthy living conditions. The "RMI" as a means of fighting exlusion enhances access to health care and improves the living conditions beneficiaries. Paradoxically, despite increasing medical consumption those beneficiaries themselves experience a deteriorating state of health. One explanation could be that they discover their true state of health and simultaneously their major preoccupation becomes their health, consequently their suffer from the positive impact of the health care element of this policy. Another explanation could be that owing to the lack of professional integration prospects inherent to "RMI" they feel discouraged and resortto illness as justification for remaining out of work.