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Article
Publication date: 19 April 2013

Mahtab Ahmad

The purpose of this paper is to assess disabled persons' access to health care, and highlight barriers.

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Abstract

Purpose

The purpose of this paper is to assess disabled persons' access to health care, and highlight barriers.

Design/methodology/approach

A total of 245 rural men and women with physical disabilities were interviewed, to determine their level of access to healthcare services. A simple composite mean of the weighted average indices of responses on the effectiveness of healthcare provision, equity, and users' satisfaction was calculated, to assess the overall level of access of the respondents to healthcare. The qualitative component highlighted an array of barriers that prevented the disabled individuals from accessing healthcare services.

Findings

The results indicated that access to the so‐called “inclusive” public healthcare for both males and females with physical disabilities was poor. The barriers identified were related to the built environments, healthcare delivery processes, and ceiling of health subsidies. The findings suggest that the absence of advocacy of disability rights and failure to adopt circumstantial equities at dispensing levels have resulted in the collapse of the promotion of disability rights at grassroots levels.

Research limitations/implications

The study is location specific (rural), and it mainly focuses on individuals with physical disabilities in working‐age (15‐35 years) to assess their access to the rural healthcare.

Originality/value

Having an effective healthcare provision in an area and its equal access to both males and females is crucially important for their social and economic development. In this paper, the assessment of access to healthcare provides both an aggregated and a disaggregated picture by gender, which is poor for individuals with physical disabilities.

Details

International Journal of Sociology and Social Policy, vol. 33 no. 3/4
Type: Research Article
ISSN: 0144-333X

Keywords

Open Access
Article
Publication date: 6 March 2017

Theresa Alfaro-Velcamp

Asylum seekers, refugees and immigrants’ access to healthcare vary in South Africa and Cape Town due to unclear legal status. The purpose of this paper is to shed light on the…

5319

Abstract

Purpose

Asylum seekers, refugees and immigrants’ access to healthcare vary in South Africa and Cape Town due to unclear legal status. The purpose of this paper is to shed light on the source of this variation, the divergence between the 1996 South African Constitution, the immigration laws, and regulations and to describe its harmful consequences.

Design/methodology/approach

Based on legal and ethnographic research, this paper documents the disjuncture between South African statutes and regulations and the South African Constitution regarding refugees and migrants’ access to healthcare. Research involved examining South African jurisprudence, the African Charter, and United Nations’ materials regarding rights to health and health care access, and speaking with civil society organizations and healthcare providers. These sources inform the description of the immigrant access to healthcare in Cape Town, South Africa.

Findings

Asylum-seekers and refugees are entitled to health and emergency care; however, hospital administrators require documentation (up-to-date permits) before care can be administered. Many immigrants – especially the undocumented – are often unable to obtain care because of a lack of papers or because of “progressive realization,” the notion that the state cannot presently afford to provide treatment in accordance with constitutional rights. These explanations have put healthcare providers in an untenable position of not being able to treat patients, including some who face fatal conditions.

Research limitations/implications

The research is limited by the fact that South African courts have not adjudicated a direct challenge to being refused care at healthcare facility on the basis of legal status. This limits the ability to know how rights afforded to “everyone” within the South African Constitution will be interpreted with respect to immigrants seeking healthcare. The research is also limited by the non-circulation of healthcare admissions policies among leading facilities in the Cape Town region where the case study is based.

Practical implications

Articulation of the disjuncture between the South African Constitution and the immigration laws and regulations allows stakeholders and decision-makers to reframe provincial and municipal policies about healthcare access in terms of constitutional rights and the practical limitations accommodated through progressive realization.

Social implications

In South Africa, immigration statutes and regulations are inconsistent and deemed unconstitutional with respect to the treatment of undocumented migrants. Hospital administrators are narrowly interpreting the laws to instruct healthcare providers on how to treat patients and whom they can treat. These practices need to stop. Access to healthcare must be structured to comport with the constitutional right afforded to everyone, and with progressive realization pursued through a non – discriminatory policy regarding vulnerable immigrants.

Originality/value

This paper presents a unique case study that combines legal and social science methods to explore a common and acute question of health care access. The case is novel and instructive insofar as South Africa has not established refugee camps in response to rising numbers of refugees, asylum seekers and immigrants. South Africans thus confront a “first world” question of equitable access to healthcare within their African context and with limited resources in a climate of increasing xenophobia.

Details

International Journal of Migration, Health and Social Care, vol. 13 no. 1
Type: Research Article
ISSN: 1747-9894

Keywords

Open Access
Article
Publication date: 17 April 2023

Noah Olasehinde, Uche Abamba Osakede and Abdulfatai Adekunle Adedeji

This study investigates the effect of user fees on access and waiting time in Nigeria. For access, the effect of user fees on both preventive and curative care; and the effect of…

1034

Abstract

Purpose

This study investigates the effect of user fees on access and waiting time in Nigeria. For access, the effect of user fees on both preventive and curative care; and the effect of user fees on waiting time at public healthcare facilities were examined. User fees are vital for the fiscal sustainability of healthcare provision for most African economies. Its imposition could debar healthcare access by the poor while its removal can reduce quality of care and induce longer waiting time.

Design/methodology/approach

The wave 3 of the Nigerian General Household Survey (2015/16) data was used for users of public health facilities. Access to healthcare was modelled using utilization data in a logistic regression model while waiting time was through the Negative Binomial Regression Model (NBRM).

Findings

The analyses showed significant effects of user fees on access to both preventive and curative care and on time spent waiting to make use of healthcare services. Individuals were able to access healthcare services regardless of amounts paid. Also, there was a non-negative effect of user fee imposition on waiting time.

Practical implications

Nigeria should improve healthcare facilities to address the enormous demand for healthcare services when designing policy for health sector.

Originality/value

This paper shows that even with the imposition of user fees, healthcare facilities could still not cater for the rising healthcare needs of the populace but cautioned that its abolition may not be a preferred option.

Details

International Journal of Health Governance, vol. 28 no. 2
Type: Research Article
ISSN: 2059-4631

Keywords

Article
Publication date: 11 June 2018

Jaclyn M. White Hughto, Kirsty A. Clark, Frederick L. Altice, Sari L. Reisner, Trace S. Kershaw and John E. Pachankis

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in…

1100

Abstract

Purpose

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues.

Design/methodology/approach

In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated.

Findings

Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated.

Research limitations/implications

Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare.

Originality/value

This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.

Details

International Journal of Prisoner Health, vol. 14 no. 2
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 1 March 2011

Boonsom Namsomboon and Kyoko Kusakabe

The purpose of this paper is to examine women homeworkers' access to healthcare services in Thailand. Specifically, it focuses on how the state's universal healthcare service…

955

Abstract

Purpose

The purpose of this paper is to examine women homeworkers' access to healthcare services in Thailand. Specifically, it focuses on how the state's universal healthcare service, introduced in the year 2002, has responded/not responded to the needs of poor women homeworkers in Bangkok.

Design/methodology/approach

Data collection was done through a structured questionnaire with 415 women homeworkers from 16 districts in Bangkok, Thailand, ten in‐depth interviews and 13 group discussions.

Findings

It was found that less than half of the women homeworker respondents accessed the universal healthcare scheme. The obstacles for access include both financial (transportation cost, loss of wage) and time. Also, homeworkers need support from the community/household to access these services. Universal health services itself is not enough to ensure access to healthcare service, especially among poor and minimally educated homeworkers with small children.

Practical implications

The research showed the need to have multiple approaches (state‐provided services and community organizing, as well as awareness among men about their role in care work), in order to ensure universal healthcare coverage.

Originality/value

Universal healthcare services are considered the best way to extend healthcare services to workers in the informal economy. This paper argues that total dependence on state‐provided services does not ensure universal healthcare coverage. There is a need for additional community‐based support mechanisms to ensure access to these services.

Details

International Journal of Sociology and Social Policy, vol. 31 no. 1/2
Type: Research Article
ISSN: 0144-333X

Keywords

Article
Publication date: 15 June 2012

Christalla Pithara, Michalinos Zembylas and Mamas Theodorou

This paper aims to discuss factors affecting temporary migrants' ability to access and make effective use of public and private healthcare services in the Republic of Cyprus…

Abstract

Purpose

This paper aims to discuss factors affecting temporary migrants' ability to access and make effective use of public and private healthcare services in the Republic of Cyprus (hereafter referred to as Cyprus). These factors are raised in the context of a larger study focusing on the healthcare needs of temporary migrants from non‐EU countries living and working in Cyprus.

Design/methodology/approach

Semi‐structured interviews with 13 domestic workers and 17 students from Sri Lanka, Pakistan, Bangladesh, India and the Philippines explored migrants' experiences with accessing and utilizing healthcare services in Cyprus. The theoretical framework utilized is grounded in the health capability approach which focuses on individuals' confidence and ability to be effective in achieving optimal health.

Findings

The study highlights issues concerning the accessibility and acceptability of healthcare services which emerge as the result of both the organisation and delivery of healthcare services and social, political and economic structures.

Research limitations/implications

The implications of this study are relevant in the current debate taking place at the EU level about the opportunities and challenges of temporary migration. Specifically, it is argued that governments and societies should promote individual freedoms and opportunities that empower people to lead the lives they want to live.

Originality/value

Temporary migrants form a group whose experiences and needs have not been as extensively investigated as those of other migrant groups, particularly in Cyprus. The capability approach allows for assessing both policy and health systems taking into consideration equity and the impact of multi‐sectoral influences on health.

Details

International Journal of Migration, Health and Social Care, vol. 8 no. 2
Type: Research Article
ISSN: 1747-9894

Keywords

Article
Publication date: 16 August 2019

Terrylyna Baffoe-Bonnie, Samuel Kojo Ntow, Kwasi Awuah-Werekoh and Augustine Adomah-Afari

The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana.

Abstract

Purpose

The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana.

Design/methodology/approach

Data were gathered using different qualitative methods (interviews and participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a framework method for the thematic analysis of the semi-structured interview data; and interpreted with the theoretical perspective of health systems thinking and innovation.

Findings

The study concludes that health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates.

Research limitations/implications

The limited facilities available and the sample size (healthcare workers and prison administrators) impeded the achievement of varied views on the topic.

Practical implications

The paper recommends the need for health policy makers and authorities of the Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to reform the prisons healthcare system.

Social implications

The national health insurance scheme was found to be the financing option for prisoners’ access to free healthcare with supplementation from the Ghana Prison Service. The study recommends that policy makers and healthcare stakeholders should understand and appreciate the reality that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery in Ghana and as such should be given the needed attention.

Originality/value

This is one of few studies conducted on male only prisoners/prison in the context of Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system achieves set objectives in response to the primary healthcare concept.

Details

International Journal of Prisoner Health, vol. 15 no. 4
Type: Research Article
ISSN: 1744-9200

Keywords

Article
Publication date: 29 August 2023

Inger Lise Teig, Kristine Bærøe, Andrea Melberg and Benedicte Carlsen

Unequal social conditions that provide people with unequal opportunities to live healthy lives are considered unjust and associated with “health inequity”. Governing power is…

Abstract

Purpose

Unequal social conditions that provide people with unequal opportunities to live healthy lives are considered unjust and associated with “health inequity”. Governing power is impacting people's lives through laws, policies and professional decisions, and can be used intentionally to combat health inequity by addressing and changing people's living- and working conditions. Little attention is paid to how these ways of exercising governing power unintentionally can structure further conditions for health inequity. In this paper, the authors coin the term “governance determinants of health” (GDHs). The authors' discussion of GDHs potential impact on health inequity can help avoid the implementation of governing strategies with an adverse impact on health equality. This paper aims to discuss the aforementioned objective.

Design/methodology/approach

The authors identify Governance Determinants of Health, the GDHs. GDHs refer to governance strategies that structurally impact healthcare systems and health equality. The authors focus on the unintended, blind sides of GDHs that maintain or reinforce the effects of socioeconomic inequality on health.

Findings

The power to organize healthcare is manifested in distinct structural approaches such as juridification, politicalization, bureaucratization and medical standardization. The authors explore the links between different forms of governance and health inequalities.

Research limitations/implications

The authors' discussion in this article is innovative as it seeks to develop a framework that targets power dynamics inherent in GHDs to help identify and avoid GDHs that may promote unequal access to healthcare and prompt health inequity. However, this framework has limitations as the real-world, blurred and intertwined aspects of governing instruments are simplified for analytical purposes. As such, it risks overestimating the boundaries between the separate instruments and reducing the complexity of how the GDHs work in practice. Consequently, this kind of theory-driven framework does not do justice to the myriad of peoples' complex empirical practices where GDHs may overlap and intertwine with each other. Nevertheless, this framework can still help assist governing authorities in imagining a direction for the impacts of GDHs on health equity, so they can take precautionary steps to avoid adverse impacts.

Originality/value

The authors develop and explore – and demonstrate – the relevance of a framework that can assist governing authorities in anticipating the impacts of GDHs on health inequity.

Details

International Journal of Health Governance, vol. 28 no. 4
Type: Research Article
ISSN: 2059-4631

Keywords

Book part
Publication date: 26 January 2023

Srishti Jaitely and Navjit Gaurav

In India, people with disabilities (PWDs) have emerged as one of the most vulnerable populations during COVID-19, particularly those living in informal settlements. Although the…

Abstract

Purpose

In India, people with disabilities (PWDs) have emerged as one of the most vulnerable populations during COVID-19, particularly those living in informal settlements. Although the government has made efforts to ensure healthcare access for all, these efforts seem inadequate considering that PWDs' needs vary greatly depending on type and degree of disability. The purpose of the study is to identify barriers in healthcare access for PWDs in Mumbai's informal settlements during COVID-19.

Methods

A qualitative approach employed multiple case study methods. Eight PWDs were selected as cases from the informal settlements of M-East Ward, Mumbai. The data was gathered using observation and interaction with the PWDs. Data were analyzed for emergent themes to explore the presence, meaning, and relationships of barriers faced by PWDs accentuated by pandemic.

Findings

Findings indicate a complex and compounded interplay of structural, administrative, psycho-social, and technological factors which created numerous challenges for PWDs to access healthcare provisions during pandemic. These factors include socioeconomic challenges, the built environment inaccessibility, limited transportation facilities, and lack of trained healthcare personnel to support PWDs.

Implications

This research adds to an understanding of the barriers faced by PWDs and provides insights for formulating contextualized policies to ensure accessible health services for PWDs when needed. Findings point out ways in which understanding the barriers would help to identify the gaps in the resource system, and to mobilize required resources in the relevant healthcare departments.

Details

Disability in the Time of Pandemic
Type: Book
ISBN: 978-1-80262-140-2

Keywords

Book part
Publication date: 15 January 2021

Thespina J. Yamanis, Ana María del Río-González, Laura Rapoport, Christopher Norton, Cristiana Little, Suyanna Linhales Barker and India J. Ornelas

Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV…

Abstract

Purpose: Fear of deportation and its relationship to healthcare access has been less studied among immigrant Latinx men who have sex with men (MSM), a population at risk for HIV and characterized by their multiple minority statuses. The first step is to accurately measure their fear of deportation.

Approach: We used an exploratory sequential mixed methods design. Eligibility criteria were that research participants be ages 18–34 years; Latinx; cisgender male; having had sex with another male; residing in the District of Columbia metro area; and not a US citizen or legal permanent resident. In Study 1, we used in-depth interviews and thematic analysis. Using participants' interview responses, we inductively generated 15 items for a fear of deportation scale. In Study 2, we used survey data to assess the scale's psychometric properties. We conducted independent samples t-test on the associations between scale scores and barriers to healthcare access.

Findings: For the 20 participants in Study 1, fear of deportation resulted in chronic anxiety. Participants managed their fear through vigilance, and behaviors restricting their movement and social network engagement. In Study 2, we used data from 86 mostly undocumented participants. The scale was internally consistent (α = 0.89) and had a single factor. Those with higher fear of deportation scores were significantly more likely to report avoiding healthcare because they were worried about their immigration status (p = 0.007).

Originality: We described how fear of deportation limits healthcare access for immigrant Latinx MSM.

Research implications: Future research should examine fear of deportation and HIV risk among immigrant Latinx MSM.

Details

Sexual and Gender Minority Health
Type: Book
ISBN: 978-1-83867-147-1

Keywords

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