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A developing body of research has demonstrated the impact of racial residential segregation on a variety of negative health outcomes. However, little is known about the effect of residential segregation on access to health care.

This study utilizes multilevel binary logit models based on individual-level health data from the 2008 Behavioral Risk Factor Surveillance System linked to metropolitan-area level data to examine the association between Black-White segregation in 136 metropolitan statistical areas in the United States and health-care coverage.

Overall, an increase in Black-White segregation is related to a decrease in the likelihood of having health insurance for Black residents and an increase in the Black-White gap in health-care coverage. These effects are substantial even when controlling for the effects of educational, social, and economic factors.

This study is the first to examine the impact of segregation on an individual's ability to access health-care coverage, which is an essential starting point for accessing health care in the United States.

Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within various communities due to the intersection of culture, gender and other identities. To date, no research has been done on the difficulties Nepalese immigrant women in Canada may face accessing PHC. The purpose of this study was to learn about their perceptions of barriers to PHC access and to share the findings with a wide range of stakeholders, including health-care providers and policymakers.

The authors conducted a community-engaged qualitative study in Calgary, Alberta, Canada. A total of six focus group discussions (FGD) among 34 participants (each FGD consisted of 5–7 participants) were conducted. The authors collected demographic information before each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were coded and analysed thematically.

The focus groups identified long wait times as a major barrier to receiving PHC services. Long wait times in emergency rooms, unable to see family doctors when they were sick, tedious referral procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and work all impacted their access to PHC. Further, a lack of proficiency in English was another significant barrier that impeded effective communication between physicians and immigrant women patients, thus compromising the quality of care. Other barriers mentioned included lack of access to medical records for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity with the Canadian health-care system.

Accessible PHC is essential for the health of immigrant populations in Canada. This study recognizes the extent of the barriers among a relatively less studied immigrant population group, Nepalese immigrant women, which will help effectively shape public policy and improve access to PHC for the versatile immigrant population fabric in Canada.

Undocumented migrants experience major legal constraints in their health-care access. Little is known on how undocumented migrants cope with these limitations in health-care access as individuals. The purpose of this study is to explore the coping responses of undocumented migrants when they experience limited health-care access in face-to-face encounters with health-care providers.

The authors conducted multi-site ethnographic observations and 25 semi-structured in-depth interviews with undocumented migrants in Belgium. They combined the “candidacy model” of health-care access with models from coping literature on racism as a framework. The candidacy model allowed them to understand access to health care as a dynamic and interactive negotiation process between health-care workers and undocumented migrants.

Responses to impaired health-care access can be divided into four main strategies: (1) individuals can react with a self-protective response withdrawing from seeking further care; (2) they can get around the obstacle; (3) they can influence the health-care worker involved by deploying discursive or performative skills; or (4) they can seek to confront the source of the obstacle.

These findings point to the importance of care relations and social networks, as well as discursive and performative skills of undocumented migrants when negotiating barriers in access to health care.

This study refines the candidacy model by highlighting how individuals respond on a micro-level to shifts towards exclusionary health policies and, by doing so dynamically, change provision of health-care services.

The objective of this paper was to systematically review published studies to determine if disability limits access to health care and to attempt to identify what body functions, structures and activities and participation, as well as contextual factors (environmental and personal factors), interact with the health condition to limit this access. The AMED, CINAHL, EMBASE, Medline and psychINFO databases were searched for original study articles in English, dating from 1974 to 2008. Review articles and expert opinion were excluded. Each study had two independent reviews by either a general practitioner or specialist in rehabilitation medicine. Each study was critically appraised according to the National Service Framework for Long‐term Conditions (Department of Health, 2005a) methodology and recorded on standardised data extraction sheets. Studies of poor quality were excluded. Sixty studies were included. No randomised controlled trials were identified. Studies broadly fell into the following three main groups: database studies (n=27), quantitative surveys (n=20) and qualitative interviews (n=13). Disabled people are restricted in accessing health care and report less satisfaction with their medical care. Many of the identified studies were from the United States (US) and based on subjective reporting. More objective evidence is needed, especially in the UK, to clarify the true level of access to health care in people with disabilities. The complex, interdependent factors in providing health care to disabled people require complex solutions.

The influx of refugees and asylum-seekers over the past decade into the European Union creates challenges to the health systems of receiving countries in the preparedness and requisite adjustments to policy addressing the new needs of the migrant population. This study aims to examine and compare policies for access to health care and the related health outcomes for refugees and asylum-seekers settling both in the UK and Germany as host countries.

The paper conducted a scoping review of academic databases and grey literature for studies within the period 2010-2017, seeking to identify evidence from current policies and service provision for refugees and asylum-seekers in Germany and the UK, distilling the best practice and clarifying gaps in knowledge, to determine implications for policy.

Analysis reveals that legal entitlements for refugees and asylum-seekers allow access to primary and secondary health care free of charge in the UK versus a more restrictive policy of access limited to acute and emergency care during the first 15 months of resettlements in Germany. In both countries, many factors hinder the access of this group to normal health care from legal status, procedural hurdles and lingual and cultural barriers. Refugees and asylum-seeker populations were reported with poor general health condition, lower rates of utilization of health services and noticeable reliance on non-governmental organizations.

This paper helps to fulfill the need for an extensive research required to help decision makers in host countries to adjust health systems towards reducing health disparities and inequalities among refugees and asylum-seekers.

The purpose of this paper is to investigate the association between social capital (SC) and health care access problem among the older people in Bangladesh.

This study applied a random sampling method to select 310 older adults (all aged 60 years) in Bangladesh. Exploratory factor analysis was employed to extract SC dimensions. Logistic regression was applied to measure the association of SC dimensions and access.

The logistic regression result shows that with a one-unit increase in social network, norms of reciprocity, and civic participation, health care access problem will be decreased by OR= 0.732 (95% CI =0.529–1.014); OR=0.641 (95% CI = 0.447–0.919); and OR=0.748 (95% CI = 0.556–1.006) units. Respondents who have economic hardship were 3.211 (OR=3.211, CI = 0.84–5.59) times more likely to say that they had health care access problem compared with who had no economic hardship.

The study showed that the lower level of SC and presence of economic hardship increased the probability to health care access problem among the older people. Improving SC may be helpful in reducing health care access problem. However, economic hardship reductions are also important to reduce the health care access problem. Improving SC and reducing economic hardship thus should be implemented at the same time.

The study showed that low SC and economic hardship increased the probability to health care access problem. Improving SC may be helpful in reducing health inequity. However, economic hardship reductions also important to health care access. Therefore, improving SC and reducing economic hardship should be implemented at the same time.

This study has a great policy importance in regard to reducing health care access problem among the older adult in Bangladesh as SC has a potential to bring about a concomitant improvement in the condition of the health care access.

Patient-centred care is a key approach used in Australia for the delivery of quality health care, and understanding experiences and perceptions is a key part to this. This paper aims to explore prisoners’ experiences and perceptions of health-care service provision in New South Wales, Australia.

In February and March 2017, 24 focus groups, consisting of 128 participants, were undertaken using semi-structured interviews that explored experiences of health care in prison.

A conceptualisation of the prisoners’ health-care experience around the core category of access to health care emerged from the data. Enablers or barriers to this access were driven by three categories: a prison construct – how the prisoners “see” the prison system influencing access to health care; a health-care system construct – how the prisoners “see” the prison health-care system and the pathways to navigate it; and personal factors. Communication was the category with the greatest number of relational connections.

This study takes a pragmatic approach to the analysis of data, the findings forming the basis for a future quantitative study. The findings identify communication as a key issue for access to health care.

This study provides first-hand accounts of enablers and barriers to accessing health-care services in the prison environment. To the best of the authors’ knowledge, this study is the first of its kind to identify access to health care as a core category and is of value to health workers and researchers that work with the prison population.

This paper aims to provide a comprehensive understanding of factors that contribute to refugees’ exclusion from health-care services. More specifically, using institutional theory, this paper identifies regulative pillar-, normative pillar- and cultural/cognitive pillar-related challenges that result in refugees having limited or no access to health-care services.

The paper draws on both secondary research and empirical insights from two qualitative fieldwork studies totaling 37 semi-structured meso-level interviews, observations and focus groups in three Turkish cities (Izmir, Ankara and Edirne), as well as a total of 42 micro-level, semi-structured interviews with refugees and migrants in one large city (Izmir) in Turkey.

This study reveals that systematically stratified legal statuses result in different levels of access to public health-care services for migrants, asylum seekers or refugees based on their fragmented protection statuses. The findings suggest access to health-care is differentiated not only between local citizens and refugees but also among the refugees and migrants based on their legal status as shaped by their country of origin.

While the role of macro challenges such as laws and government regulations in shaping policies about refugees have been examined in other fields, the impact of such factors on refugee services and well-being has been largely ignored in service literature in general, as well as transformative service research literature in particular. This study is one of the first attempts by explicitly including macro-level factors to contribute to the discussion on the refugees’ access to public health-care services in a host country by relying on the institutional theory by providing a holistic understanding of cognitive, normative and regulative factors in understanding service exclusion problem.

A common observation is that both single- and multi-payer health care systems will achieve lower overall costs if they use primary care gatekeeping. Questioning this common wisdom, we focus on the health care access system, that is, the way in which patients gain access to health care. Gatekeeping, the use of primary care providers to control access to more specialized physician and hospital services, has come under intense scrutiny in the United States and in Europe. The few international comparative studies that have focused on the issues of quality of care, cost containment, and patient satisfaction find weak or no support for common assumptions about gatekeeping. Hence, we examine the institutional environments in seven countries in order to: (a) define and categorize health care access systems; (b) identify the components of a health care access system; (c) explore the notion of a strategic fit between health care financing systems and access system configurations; and (d) propose that the health care access system is a key determinant of process-level cost efficiency. Drawing upon institutional and governance theories, we posit that the structure and organization of an access system is determined by how it addresses six essential questions: Who is covered? Which services are included? What are the points of access? How much time elapses before access? What are the ways of selecting among points of access? and Are services and their quality the same for everyone? This analytical framework reveals that national health care access systems vary the most in their points of access, access times, and selection mechanisms. These findings and our explanations imply that access systems are one of the only tools for demand management, that any lasting change to an access system typically is implemented over an extended time period, and that managers of health care organizations often have limited freedom to define governance structures and shape health care service production systems.

This chapter examines the relationship between health service restructuring and the health care experiences of women from rural and remote areas of Canada. Data were collected from 34 focus groups (237 women), 15 telephone interviews and 346 responses from an online survey. Access to services, care quality and satisfaction are salient themes in these data. Problems include: travel, shortage of providers, turnover in personnel, delays associated in accessing care, lack of knowledge of women's health issues and patronizing attitudes of some health care providers. Health care service restructuring has led to deterioration in service availability and quality. Key areas for policy development need to address health care access and quality improvement issues, including increasing access to more (particularly female) providers who are sensitive to women's health issues.