Parcours de soins en situation de précarité : entre détermination et individualisation.

The purpose of this article is to analyse healthcare pathways for precarious people, based on the results of a field study conducted in 2011 and 2012 in the north of France and Burgundy. About 40 semi-directed interviews were conducted in order to collect healthcare pathways narratives revolving around various health events during the subject's life, and putting them in perspective with individual, familial stories as well as their environment (social environment, healthcare organization, etc.).The results indicate various types of determinants, firstly concerning norms and rules determining access to health insurance and health services. Despite the positive effects of CMUc (means-tested complementary health insurance) and ACS (financial support to purchase complementary insurance), healthcare pathways are still strongly constrained economically, especially for those people above the threshold and those without complementary health insurance. Moreover, we identified a deprivation culture acquired during childhood that continues to shape adulthood pathways. Finally, subjective experiences of disqualification and symbolic violence frequently reported by precarious people contribute to avoidance of social welfare and/or health institutions in order to preserve a weakened identity. Despite these determinations, every healthcare pathway appears to be unique because it belongs to a life story and occurs in a context with renewed meaning. Personhood is negotiated through the health care pathway.