The gap between entitlement and access to healthcare: An analysis of "candidacy" in the help-seeking trajectories of asylum seekers in Montreal
The gap between entitlement and access to healthcare: An analysis of "candidacy" in the help-seeking trajectories of asylum seekers in Montreal
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DOI：
10.1016/j.socscimed.2017.03.038
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发表时间：
2017-06-01
影响因子：
5.4
通讯作者：
Rousseau, Cecile
中科院分区：
文献类型：
--
作者：
Chase, Liana E.;Cleveland, Janet;Rousseau, Cecile
2012 年，加拿大政府大幅削减了其历来强大的联邦难民健康保险计划。虽然这项政策对魁北克省寻求庇护者的承保水平影响微乎其微，但有证据表明，在随后发生的两极分化的全国辩论期间，该群体的医疗保健机会仍然减少。这项研究采用了医疗保健获取的“候选”模型来阐明导致观察到的权利和获取之间差距的因素。对蒙特利尔的寻求庇护者进行了二十五次半结构化访谈，以引出他们在寻求医疗保健时遇到的困难的叙述性叙述。主题内容分析结合对寻求帮助轨迹的全面检查揭示了获得护理的几个重要障碍，包括关于难民健康保险的普遍混乱和错误信息、针对寻求庇护者的繁琐行政程序以及漫长的等待时间。与不稳定的移民身份相关的边缘化和不安全感似乎放大了这些护理障碍的影响，即使是很小的获得困难，也可能对未来的寻求帮助和获得结果产生巨大影响。参与者表现出对质疑他们是否值得获得医疗保险的公共话语的认识，经常将获取困难解释为卫生专业人员不愿意为他们服务的证据。这种解释与庇护申请程序相关的恐惧交织在一起，压制自我宣传、进一步寻求帮助，有时甚至压制信息寻求。这一发现特别重要，因为它表明了一种机制，通过这种机制，在西方东道国日益盛行的对强迫移民的敌对公开表现本身可能会危及高度弱势群体的身体、心理和社会健康，即使存在强有力的权利政策。最后，我们反思了如何调整医疗保健获取的理论模型，以更好地适应不稳定身份移民的独特经历。 (C) 2017 Elsevier Ltd. 保留所有权利。
In 2012 the Canadian government made significant cuts to its historically strong federal refugee health coverage plan. While this policy had negligible effects on the level of coverage provided to asylum seekers in Quebec, there is evidence that this group nonetheless experienced reduced healthcare access during the period of polarized national debate that ensued. This study engaged the "candidacy" model of healthcare access to illuminate factors contributing to the observed gap between entitlement and access. Twenty-five semi-structured interviews were conducted with asylum seekers in Montreal to elicit narrative accounts of difficulties encountered in the pursuit of healthcare. Thematic content analysis in conjunction with a holistic examination of help-seeking trajectories revealed several important barriers to obtaining care, including widespread confusion and misinformation about refugee health coverage, cumbersome administrative procedures specific to asylum seekers, and long wait times. Feelings of marginalization and insecurity associated with precarious migratory status appeared to amplify the effects of these barriers to care such that even a minor access difficulty, could have dramatic effects on future help-seeking and access outcomes. Demonstrating awareness of public discourses interrogating their deservingness of health coverage, participants often interpreted access difficulties as evidence of health professionals' unwillingness to serve them. Such interpretations conspired with fears associated with the asylum claim process to suppress self-advocacy, further help-seeking, and at times even information-seeking. This finding is particularly significant in that it suggests a mechanism through which hostile public representations of forced migrants increasingly prevalent in Western host countries can themselves endanger the physical, psychological, and social health of highly disadvantaged populations, even in the presence of strong entitlement policies. We close with reflections on how theoretical models of healthcare access might be adjusted to better accommodate the unique experiences of precarious status migrants. (C) 2017 Elsevier Ltd. All rights reserved.