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1 – 10 of over 116000Kayla Halsey, Salameh Alarood, Mohammed Nawaiseh and Ghazala Mir
Refugees commonly face inequitable access to health care services in their host country. This study aimed to identify factors influence refugee access to health services and to…
Abstract
Purpose
Refugees commonly face inequitable access to health care services in their host country. This study aimed to identify factors influence refugee access to health services and to assess perceptions of barriers to health care for different refugee groups in Jordan.
Design/methodology/approach
In-depth interviews were combined with document analysis and analyzed using thematic and framework methods.
Findings
Findings highlighted inequitable access to health services between different refugee groups. Unlike Palestinian refugees from the West Bank, Palestinian refugees from Gaza faced financial barriers to access health care as a result of citizenship status, which affected their health insurance, referrals for health care and legal right to work. Syrian refugees similarly lacked Jordanian citizenship and health insurance and mainly depended on UNHCR for health services, though some were able to acquire work permits and pay for private care.
Originality/value
This study demonstrates a need for politically and economically appropriate policies to minimize the disparity of health care access among these refugee groups.
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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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
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Ibraheem Khaled Abu Siam and María Rubio Gómez
Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing…
Abstract
Purpose
Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan.
Design/methodology/approach
This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact.
Findings
The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake.
Originality/value
Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.
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Adam Capon, Lien McGowan and Julia Bowman
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
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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…
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.
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Luma AlMasarweh and Carol Ward
This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen interviews were…
Abstract
Purpose
This study aims to provide a better understanding of Native American women veterans’ experiences with Veteran Administration and Indian Health Services. Eighteen interviews were conducted with special attention to the quality and quantity of health and mental health care services veterans accessed, the barriers and local contextual factors in accessing and utilizing services, and potential solutions to service gaps for women veterans from two Montana reservations, the Northern Cheyenne Reservation and the Confederated Salish and Kootenai Tribes of the Flathead Reservation.
Methodology/approach
We examine the barriers and needs of Native American veterans in both reservations using qualitative methods. The research analyzed 18 interviews with women veterans from the Northern Cheyenne and Flathead reservations.
Findings
Native American women veterans identified a number of barriers to accessing care, some of which include lack of information regarding eligibility and the types of services available. Women often found the application process to be confusing and difficult. Other barriers included distance, cost of travel, and conflicts with their work schedule.
Research limitations/implications
This exploratory case study served to clarify the challenges and obstacles Native American women veterans experience with accessing health and mental health services. This research revealed several patterns and themes in the experience of Native American women veterans in both reservation communities when attempting to access and seek care at Veterans Administration (VA) facilities and Indian Health Services (IHS). This research calls for policy changes and research to clarify how resources can be more efficiently and effectively distributed to rural veterans.
Originality/value
Little research has addressed the needs of Native American veterans. American Indians and Alaska Natives serve at a higher rate in the U.S. military than any other population. This research provides important information about Native American veterans who are often underrepresented in survey research, yet a rapidly growing segment of the United States military and veteran population.
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Kathryn Freeman Anderson and Andrew S. Fullerton
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…
Abstract
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.
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Aktieva Tri Tjitrawati and Mochamad Kevin Romadhona
This study aims to analyse in the health access of Indonesian illegal migrant workers in Malaysia, during which time they were not covered by Indonesia’s national social health…
Abstract
Purpose
This study aims to analyse in the health access of Indonesian illegal migrant workers in Malaysia, during which time they were not covered by Indonesia’s national social health insurance.
Design/methodology/approach
This study adopted a sociolegal approach, the research approach is conducted to understand the effect of a law, policy and regulation on access to health-care access among Indonesian migrant workers working illegally in Malaysia. This research involved 110 respondents who work illegally in Malaysia. The research explored the perceptions of respondents concerning to health access services of illegal migrant workers.
Findings
The study demonstrated the weakness of provisions intended to guarantee the health access to health care of migrant workers from Indonesia illegally working in Malaysia. A decline in health status was observed, but it was not significant. Bilateral cooperation between Indonesia and Malaysia is necessary to provide a framework for Indonesia providing health care to its citizens working in Malaysia, regardless of their legal status.
Originality/value
This paper concerns on the Indonesia illegal migrant workers experiencing illness and the access to the health service in Malaysia, and also the implementation of international regulation to protect Indonesian illegal migrant workers in Malaysia under ASEAN Consensus on the Protection and Promotion of the Rights of Migrant Workers.
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Samuel Adusei, Dorcas Nuertey and Emmanuel Poku
This study investigated the relationship between last-mile distribution or delivery (LMD) and commodity access through the mediating role of commodity availability and commodity…
Abstract
Purpose
This study investigated the relationship between last-mile distribution or delivery (LMD) and commodity access through the mediating role of commodity availability and commodity security and the moderating effect of supply chain integration (SCI).
Design/methodology/approach
The study adopted the survey research design and employed the questionnaire instrument in collecting primary data from respondents in Eastern Regional Health Institutions in Ghana. The total number of valid responses received was 204. The partial least squares structural equation modeling (PLS-SEM) approach was adopted to analyze the relationship between the study variables.
Findings
The findings showed that there is a positive and significant relationship between LMD and commodity availability as well as LMD and commodity security. Moreover, while the relationship between commodity availability and commodity access is positive and significant, that between commodity security and commodity access is positive but insignificant. Furthermore, there is a positive and statistically significant relationship between LMD and commodity access. The study discovered that the interaction between LMD and commodity access is insignificant and negatively affected by SCI.
Originality/value
To the best of the authors' knowledge, no previous studies have empirically verified the effect of LMD on commodity access in the presence of mediating factors such as commodity availability and commodity security and SCI as the moderating factors.
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Rudra Dahal, Kalpana Thapa Bajgain, Bishnu Bahadur Bajgain, Kamala Adhikari, Iffat Naeem, Nashit Chowdhury and Tanvir C. Turin
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Originality/value
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.
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