Centralization of care in high volume hospitals and inequalities in access to care.

In 2018, the French National Health Insurance proposed to increase the minimum volume threshold for breast cancer and to set a specific threshold for ovarian cancer in order to get an authorization to treat these patients. Using an exhaustive nationwide data set, the aim of this study is to evaluate the impact of the application of minimum volume thresholds for breast cancer and ovarian cancer in France on socioeconomic and spatial inequalities in patient access to care, taking into account patient preferences for their preferred provider. Our findings indicate that it would increase spatial inequalities and introduce socioeconomic inequalities in access to specialized care in terms of travel distance and will contribute to the medical desertification in rural areas that already have less access to non-specialized care. Our results underline that ignoring patient preferences when assessing the impact of such policies drastically underestimate the deterioration in patient access to care.