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Le sentiment d’abandon progresse. Retarder encore des mesures puissantes et efficaces, c’est risquer d’atteindre un point de rupture irréversible. Depuis plusieurs décennies, la combinaison de facteurs démographiques et de politiques publiques soit inadaptées, soit insuffisamment volontaristes, a conduit à une aggravation continue de la désertification médicale. L’enjeu des inégalités d’accès aux soins n’est pas nouveau, mais l’urgence continue de grandir. En termes d’accès aux soins, les inégalités entre les territoires sont flagrantes. Pire, elles continuent de s’accroître. Entre 2010 et 2024, selon le Conseil National de l’Ordre des médecins, la densité médicale est en hausse dans 31 départements, alors qu’elle s’est détériorée dans les 69 autres. Le nombre de médecins en activité régulière par habitant en Creuse a ainsi diminué de 31 %, quand il augmentait de 16 % dans les Hautes-Alpes. Ces chiffres alarmants masquent également de fortes disparités au sein des départements, qu’il est plus que jamais nécessaire de niveler. Selon les chiffres du ministère de la santé, la désertification médicale touche près de neuf millions de Français. Pour","articles":[{"num":"1er","extrait":"I. – Le chapitre Ier du titre Ier de la quatrième partie du code de la santé publique est ainsi modifié : 1° L’article L. 4111-1 est complété par un alinéa ainsi rédigé : « Les médecins sont autorisés à exercer leur activité en ville dans les conditions prévues à l’article L. 4111-1-3. » ; 2° Après l’article L. 4111-1-2, il est inséré un article L. 4111-1-3 ainsi rédigé : « Art. L. 4111-1-3. – L’installation d’un médecin en ville est soumise à l’autorisation préalable du directeur général de l’agence régionale de santé compétente après avis rendu dans les trente jours suivant sa saisine, du conseil départemental de l’ordre dont il relève. « Si le lieu d’installation du médecin est situé dans une zone caractérisée par une offre de soins insuffisante ou par des difficultés dans l’accès aux soins au sens du 1° de l’article L. 1434-4, l’autorisation est délivrée de droit. « Dans le cas contraire, l’autorisation d’installation ne peut être délivrée qu’à la condition qu’un médecin de la même spécialité et exerçant dans la même zone cesse concomitamment son activité. Cette autorisation est de droit. « Les conditions d’application du présent article sont définies par un décret en Conseil d’État pris, après avis du conseil national de l’ordre des médecins. » II. – Le I du présent article entre en vigueur à la date de publication du décret prévu au dernier alinéa de l’article L. 4111-1-3 du code de la santé publique, et au plus tard un an après la promulgation de la présente loi.","resume":"Soumet l'installation d'un médecin en ville à l'autorisation de l'agence régionale de santé, de droit en zone sous-dotée, sinon subordonnée au départ simultané d'un confrère de même spécialité."},{"num":"2","extrait":"L’article L. 162-5-3 du code de la sécurité sociale est complété par un alinéa ainsi rédigé : « 6° Lorsque le patient ne parvient pas à désigner un médecin traitant. »"},{"num":"3","extrait":"I. – L’article L. 632-1 du code de l’éducation est ainsi modifié : 1° La première phrase du premier alinéa est complétée par les mots : « de manière à garantir un accès démocratique, déconcentré et de proximité sur l’ensemble du territoire national » ; 2° Après le même premier alinéa, il est inséré un alinéa ainsi rédigé : « Les unités de formation et de recherche en santé proposent dans chaque département des enseignements correspondant au minimum à la première année du premier cycle des formations de médecine, de pharmacie, d’odontologie et de maïeutique en particulier dans les zones caractérisées par une offre de soins insuffisante ou des difficultés dans l’accès aux soins telles que définies au 1° de l’article L. 1434-4 du code de la santé publique. » ; II. – L’article L. 6141‐2 du code de la santé publique est complété par un alinéa ainsi rédigé : « Chaque région comprend au moins un centre hospitalier universitaire. » III. – Le II du présent article entre en vigueur le 1 er janvier 2030. Un décret, pris après avis de l’Assemblée de Corse, détermine les modalités d’application du même II en établissant le calendrier de la mise en place progressive d’un centre hospitalier régional puis d’un centre hospitalier universitaire au sein du chef‐lieu de la collectivité de Corse."},{"num":"4","extrait":"Au second alinéa de l’article L. 1110-4-1 du code de la santé publique, après le mot : « État », sont insérés les mots : « participent et »."},{"num":"5","extrait":"I. – La charge pour l’État est compensée à due concurrence par la création d’une taxe additionnelle à l’accise sur les tabacs prévue au chapitre IV du titre I er du livre III du code des impositions sur les biens et services. II. – La charge pour les organismes de sécurité sociale est compensée à due concurrence par la majoration de l’accise sur les tabacs prévue au chapitre IV du titre I er du livre III du code des impositions sur les biens et services.","resume":"Compense la charge pour l'État par une taxe additionnelle à l'accise sur les tabacs et celle des organismes de sécurité sociale par une majoration de cette accise."}],"pdfUrl":"https://www.assemblee-nationale.fr/dyn/17/textes/l17b0966_proposition-loi.pdf","pdfPages":null},"dispositionsVersion":6},"stade":{"cle":"depose","etiquette":"Déposé, non adopté à ce jour","phrase":"Ce texte a été déposé le 13 février 2025. Il n'a pas été adopté à ce jour : ce n'est pas la loi.","garde":"Ce résumé décrit ce que le texte propose. Ce n'est pas le droit en vigueur."},"linkedScrutins":[{"id":"VTANR5L17V1213","titre":"le sous-amendement n° 125 de M. Bazin à l'amendement n° 55 de M. 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Le point qui décide le plus de sa portée est l'article 1 : il soumet l'installation de tout médecin (libéral ou salarié, généraliste ou spécialiste) à une autorisation préalable de l'agence régionale de santé, délivrée de droit dans les zones sous-dotées mais conditionnée, dans les zones considérées sur-dotées, au départ d'un praticien de même spécialité. Le texte prévoit aussi la suppression de la majoration de participation pour les patients sans médecin traitant, le rétablissement d'une permanence des soins ambulatoires obligatoire étendue aux spécialistes, une territorialisation des études de santé et une mission de solidarité territoriale obligatoire dans les zones prioritaires. Il a été adopté contre l'avis défavorable du gouvernement, qui lui préférait des mesures de formation et d'incitation, avant sa transmission au Sénat.","dynamique":"Adopté le 7 mai 2025 : 99 voix pour, 9 contre, 10 abstentions. Huit groupes ont voté pour, un s’est abstenu et un s’est partagé à égalité.","arguments":{"pour":[{"qui":"Guillaume Garot (Socialistes, rapporteur)","texte":"Rapporteur du texte, il conclut le débat sur le terrain de l’égalité républicaine : la République doit veiller sur chacun de nous, « qui que nous soyons, où que nous habitions », et « notre santé ne peut pas dépendre de notre code postal ». Il se dit fier du travail collectif accompli et estime que l’Assemblée a avancé pour redonner au pays « la cohésion qu’il mérite ».","source":"Compte rendu de la 2e séance du 7 mai 2025 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/comptes-rendus/seance/CRSANR5L17S2025O1N186#3731168"},{"qui":"Yannick Favennec-Bécot (LIOT)","texte":"Premier membre du groupe transpartisan créé en juillet 2022 à l’initiative du rapporteur, il rappelle que ce groupe réunit depuis 2024 cent députés issus de neuf groupes et que 256 collègues ont cosigné la proposition de loi. Il conclut que l’Assemblée va « enfin contribuer à réduire l’inacceptable inégalité territoriale d’accès aux soins ».","source":"Compte rendu de la 2e séance du 7 mai 2025 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/comptes-rendus/seance/CRSANR5L17S2025O1N186#3730917"},{"qui":"Une large majorité transpartisane (La France insoumise, Socialistes, Écologistes, Droite Républicaine, Les Démocrates, Horizons, LIOT, Gauche démocrate et républicaine)","texte":"Chacun de ces groupes a voté majoritairement pour l'ensemble du texte le 7 mai, de quelques voix au sein de la Droite Républicaine à plus de vingt-cinq au sein des Socialistes, donnant au texte sa dimension transpartisane revendiquée par ses porteurs.","source":"Assemblée nationale, analyse du scrutin n° 1607","url":"https://www.assemblee-nationale.fr/dyn/17/scrutins/1607"}],"contre":[{"qui":"Stéphanie Rist (Ensemble pour la République)","texte":"Juge la régulation de l’installation inefficace face à la pénurie de médecins : « cette proposition de loi est inefficace » et « réguler la pénurie ne sert à rien ». Elle reproche aux auteurs de n’avoir jamais dit dans quelle ville « nous pourrions prendre des médecins », ni où ceux-ci seraient trop nombreux.","source":"Compte rendu de la 2e séance du 7 mai 2025 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/comptes-rendus/seance/CRSANR5L17S2025O1N186#3730950"},{"qui":"Cyrille Isaac-Sibille (Les Démocrates)","texte":"Sans contester le constat, il juge que la proposition de loi envoie « trois mauvais messages ». D’abord, elle « ne fera qu’aggraver le déclin de la médecine libérale », alors que seuls 14 % des jeunes diplômés s’installent dans l’année qui suit l’obtention de leur diplôme. Ensuite, elle laisse croire que le problème des déserts médicaux va être réglé, ce dont il n’est pas persuadé.","source":"Compte rendu de la 2e séance du 7 mai 2025 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/comptes-rendus/seance/CRSANR5L17S2025O1N186#3730905"},{"qui":"Yannick Neuder (ministre chargé de la Santé et de l'accès aux soins)","texte":"Partage le constat mais pas le remède : « si j’avais pensé que la régulation est le bon remède à la situation, je l’aurais soutenue ». Il oppose à la contrainte la formation (suppression du numerus apertus, hausse des capacités d’accueil des universités, passerelles) et une obligation faite aux médecins, selon leurs capacités, d’assurer jusqu’à deux jours par mois une présence dans les déserts médicaux.","source":"Compte rendu de la 2e séance du 7 mai 2025 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/comptes-rendus/seance/CRSANR5L17S2025O1N186#3731170"}],"reserves":[{"qui":"Claire Marais-Beuil (Rassemblement national)","texte":"Annonce à la tribune que son groupe s’abstiendra, ce que confirme le scrutin (aucune voix pour ni contre, huit abstentions) : « Nous nous abstiendrons sur ce texte », en espérant que les sénateurs supprimeront l’article 1er. Elle juge que « Restreindre la liberté d’installation est une fausse bonne idée » et privilégie la formation et les incitations.","source":"Compte rendu de la 2e séance du 7 mai 2025 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/comptes-rendus/seance/CRSANR5L17S2025O1N186#3730939"},{"qui":"Groupe Ensemble pour la République (macronistes)","texte":"Plutôt qu'une position unifiée, le groupe s'est trouvé divisé lors du scrutin : parmi ses membres ayant pris part au vote, quatre ont voté pour et quatre contre (dont Stéphanie Rist), la grande majorité du groupe n'ayant pas pris part au vote.","source":"Analyse du scrutin n° 1607 (Assemblée nationale)","url":"https://www.assemblee-nationale.fr/dyn/17/scrutins/1607"},{"qui":"Intersyndicale de médecins, internes et étudiants (dont ISNI, MG France, CSMF, ANEMF, ReAGJIR)","texte":"Dans un communiqué commun, les organisations syndicales et représentatives des médecins, des internes et des étudiants déclarent leur opposition ferme et unanime à la régulation à l'installation et à la garde obligatoire. Elles soutiennent que le problème majeur est le déclin de la démographie médicale et non l'absence de régulation, et qu'une régulation coercitive aurait des effets contre-productifs : détourner les futurs médecins du modèle libéral vers le salariat, qui contribue peu à la permanence des soins, et favoriser les grandes structures privées.","source":"Communiqué commun des organisations représentatives des médecins, des internes et des étudiants","url":"https://www.mgfrance.org/actualites/publication/communiques-en-commun/ppl-garot"},{"qui":"Raphaël Dachicourt, président du syndicat des jeunes médecins généralistes ReAGJIR","texte":"Qualifie la mesure de liberticide, parce qu'elle vient selon lui empiéter sur la liberté d'installation. Médecins et étudiants ont manifesté à Paris, Lille, Lyon et Toulouse le 29 avril 2025, après un appel à la grève illimitée.","url":"https://www.politis.fr/articles/2025/05/deserts-medicaux-une-proposition-de-loi-transpartisane-garot-contestee-par-la-profession/","source":"Politis, mai 2025"}]},"sources":[{"label":"Assemblée nationale, analyse du scrutin n° 1607 (7 mai 2025)","url":"https://www.assemblee-nationale.fr/dyn/17/scrutins/1607"},{"label":"Assemblée nationale, dossier législatif contre les déserts médicaux","url":"https://www.assemblee-nationale.fr/dyn/17/dossiers/contre_deserts_medicaux_17e"},{"label":"Déserts médicaux : l'Assemblée adopte la loi qui prévoit de réguler l'installation des médecins, LCP, 8 mai 2025","url":"https://lcp.fr/actualites/deserts-medicaux-l-assemblee-adopte-la-proposition-de-loi-qui-prevoit-de-reguler-l"},{"label":"Guillaume Garot : notre santé ne peut pas dépendre de notre code postal, Le Quotidien du Médecin, 21 mars 2025","url":"https://www.lequotidiendumedecin.fr/jeunes-medecins/installation/guillaume-garot-depute-socialiste-de-la-mayenne-notre-sante-ne-peut-pas-dependre-de-notre-code"},{"label":"Déserts médicaux : une proposition de loi transpartisane contestée par la profession, Politis, mai 2025","url":"https://www.politis.fr/articles/2025/05/deserts-medicaux-une-proposition-de-loi-transpartisane-garot-contestee-par-la-profession/"}],"v":2,"source":"cure-verifie"},"explain":{"scrutinId":"VTANR5L17V1607","version":2,"titre":"l'ensemble de la proposition de loi visant à lutter contre les déserts médicaux, d'initiative transpartisane (première lecture).","synthese":"**Lutte contre les déserts médicaux** : le texte visait à améliorer l'accès aux soins dans les zones peu desservies. Le scrutin a été **adopté** avec un large soutien de la majorité des groupes parlementaires. **EPR**, **LFI-NFP**, **SOC**, **DR**, **ECOS**, **DEM**, **HOR**, **LIOT** et **GDR** se sont prononcés en faveur du texte. **RN** a choisi l'abstention. **EPR** a voté pour, mais reste divisé sur d'autres sujets.","perFamille":{"DEM":"a voté pour","DR":"a voté pour","ECOS":"a voté pour","EPR":"a voté pour (groupe divisé)","GDR":"a voté pour","HOR":"a voté pour","LFI-NFP":"a voté pour","LIOT":"a voté pour","SOC":"a voté pour","RN":"s'est abstenu·e"},"source":"ollama/qwen3:14b"},"objMoyens":null,"recoExperts":null,"eli":null,"promulgation":null,"commissionAmdt":{"nTotal":79,"nAdopte":8,"commissions":["Affaires sociales"],"leg":17},"rapportsDossier":[{"u":"RAPPANR5L17B1180","commission":"Commission des affaires sociales","date":"2025-03-26","num":"1180","leg":17,"type":"permanent","rapporteurs":[{"id":"PA333285","label":"Guillaume Garot"}]}],"censures":null,"voteRef":{"id":"VTANR5L17V1607","titre":"l'ensemble de la proposition de loi visant à lutter contre les déserts médicaux, d'initiative transpartisane (première lecture).","date":"2025-05-07","sortCode":"adopté","pour":99,"contre":9,"abstention":10},"voteAggregat":{"PO845401":{"pour":0,"contre":0,"abstention":8,"nonVotant":0,"absent":115,"positionMajoritaire":"abstention","nombreMembres":123},"PO845407":{"pour":4,"contre":4,"abstention":0,"nonVotant":1,"absent":85,"positionMajoritaire":"pour","nombreMembres":94},"PO845413":{"pour":23,"contre":0,"abstention":0,"nonVotant":0,"absent":48,"positionMajoritaire":"pour","nombreMembres":71},"PO845419":{"pour":26,"contre":1,"abstention":0,"nonVotant":0,"absent":39,"positionMajoritaire":"pour","nombreMembres":66},"PO845425":{"pour":4,"contre":2,"abstention":0,"nonVotant":0,"absent":42,"positionMajoritaire":"pour","nombreMembres":48},"PO845439":{"pour":17,"contre":0,"abstention":0,"nonVotant":1,"absent":20,"positionMajoritaire":"pour","nombreMembres":38},"PO845454":{"pour":8,"contre":1,"abstention":1,"nonVotant":0,"absent":26,"positionMajoritaire":"pour","nombreMembres":36},"PO845470":{"pour":5,"contre":0,"abstention":1,"nonVotant":0,"absent":27,"positionMajoritaire":"pour","nombreMembres":33},"PO845485":{"pour":4,"contre":1,"abstention":0,"nonVotant":0,"absent":18,"positionMajoritaire":"pour","nombreMembres":23},"PO845514":{"pour":7,"contre":0,"abstention":0,"nonVotant":0,"absent":10,"positionMajoritaire":"pour","nombreMembres":17},"PO847173":{"pour":0,"contre":0,"abstention":0,"nonVotant":0,"absent":16,"positionMajoritaire":"pour","nombreMembres":16},"PO840056":{"pour":1,"contre":0,"abstention":0,"nonVotant":0,"absent":10,"positionMajoritaire":"pour","nombreMembres":11}},"voteGroupes":[{"id":"PO845413","code":"LFI","libelle":"La France insoumise - 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