Department of Sociology and Anthropology, 120 Université Ottawa, Ottawa, ON, K1N 6N5 Canada.
Soc Sci Med. 2013 Sep;93:78-85. doi: 10.1016/j.socscimed.2013.06.008. Epub 2013 Jun 18.
The Canadian government's recent cuts to healthcare coverage for refugee claimants has rekindled the debate in Canada about what medical services should be provided to individuals with precarious immigration status, and who should pay for these services. This article further explores this debate, focussing on the perceptions of healthcare workers in Montreal, a large multiethnic Canadian city. In April-June 2010, an online survey was conducted to assess how clinicians, administrators, and support staff in Montreal contend with the ethical and professional dilemmas raised by the issue of access to healthcare services for pregnant women and children who are partially or completely uninsured. Drawing on qualitative analysis of answers (n = 237) to three open-ended survey questions, we identify the discursive frameworks that our respondents mobilized when arguing for, or against, universal access to healthcare for uninsured patients. In doing so, we highlight how their positions relate to their self-evaluations of Canada's socioeconomic situation, as well as their ideological representations of, and sense of social connection to, precarious status immigrants. Interestingly, while abstract values lead some healthcare workers to perceive uninsured immigrants as "deserving" of universal access to healthcare, negative perceptions of these migrants, coupled with pragmatic considerations, pushed most workers to view the uninsured as "underserving" of free care. For a majority of our respondents, the right to healthcare of precarious status immigrants has become a "privilege", that as taxpayers, they are increasingly less willing to contribute to. We conclude by arguing for a reconsideration of access to healthcare as a right, and offer recommendations to move in this direction.
加拿大政府最近削减了对难民申请人的医疗保健覆盖范围，这重新引发了加拿大关于应该为那些移民身份不稳定的个人提供哪些医疗服务以及谁应该为这些服务付费的辩论。本文进一步探讨了这场辩论，重点关注了加拿大大城市蒙特利尔的医疗保健工作者的看法。2010 年 4 月至 6 月，进行了一项在线调查，以评估蒙特利尔的临床医生、管理人员和支持人员如何应对为部分或完全没有保险的孕妇和儿童提供医疗服务的机会问题所引发的伦理和职业困境。通过对三个开放式调查问题的回答（n=237）进行定性分析，我们确定了我们的受访者在争取或反对为没有保险的患者提供全民医疗保健时所采用的话语框架。通过这样做，我们强调了他们的立场如何与他们对加拿大社会经济状况的自我评价以及他们对不稳定身份移民的意识形态代表和社会联系感相关。有趣的是，尽管抽象价值观使一些医疗保健工作者认为没有保险的移民“值得”获得全民医疗保健，但对这些移民的负面看法以及实际考虑因素促使大多数工作人员认为没有保险的人“不值得”免费护理。对于我们的大多数受访者来说，不稳定身份移民的医疗保健权利已成为一种“特权”，作为纳税人，他们越来越不愿意为此做出贡献。我们的结论是，需要重新考虑将医疗保健作为一项权利，并提出了朝着这个方向发展的建议。
