SHERPA Research Centre, CIUSSS Centre-Ouest de l'Ile de Montréal, CLSC Parc Extension, 7085, Rue Hutchison, Montréal, QC H3N 1Y9, Canada; McGill University Health Centre Research Institute, 2155 Rue Guy, Montréal, QC H3H 2L9, Canada.
Division of Social and Transcultural Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada.
Soc Sci Med. 2017 Jun;182:52-59. doi: 10.1016/j.socscimed.2017.03.038. Epub 2017 Mar 21.
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.
2012 年，加拿大政府大幅削减了其历史上强大的联邦难民健康保险计划。虽然这项政策对魁北克的寻求庇护者的保险范围几乎没有影响，但有证据表明，在随后的两极化全国辩论期间，这一群体的医疗保健获取机会确实减少了。本研究采用“候选资格”模型来阐明导致权利与获取之间差距的因素。在蒙特利尔对 25 名寻求庇护者进行了半结构化访谈，以获取他们在寻求医疗保健过程中遇到困难的叙述。主题内容分析结合对寻求帮助轨迹的整体考察揭示了获得护理的几个重要障碍，包括对难民健康保险的广泛混淆和误解、寻求庇护者特有的繁琐行政程序，以及长时间的等待。与不稳定移民身份相关的边缘化和不安全感似乎放大了这些障碍对护理的影响，以至于即使是轻微的获取困难也可能对未来的寻求帮助和获取结果产生巨大影响。参与者意识到公众对他们获得健康保险的权利的质疑，他们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。这种解释与寻求庇护过程中产生的恐惧相结合，抑制了自我倡导、进一步寻求帮助，有时甚至是信息寻求。这一发现意义重大，因为它表明了一种机制，即西方收容国日益流行的对被迫移民的敌对公众描述如何能够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。我们在结束时反思了医疗保健获取的理论模型如何进行调整，以更好地适应不稳定身份移民的独特体验。
