Rink N, Muttalib F, Morantz G, Chase L, Cleveland J, Rousseau C, Li P
Department of Paediatrics, The Montreal Children's Hospital, McGill University, Montreal, Quebec.
School of Oriental and African Studies, University of London, London, UK.
Paediatr Child Health. 2017 Nov;22(8):430-437. doi: 10.1093/pch/pxx115. Epub 2017 Oct 31.
In June 2012, the government of Canada severely restricted the scope of the Interim Federal Health Program that had hitherto provided coverage for the health care needs of refugee claimants. The Quebec government decided to supplement coverage via the provincial health program. Despite this, we hypothesized that refugee claimant children in Montreal would continue to experience significant difficulties in accessing basic health care.
(1) Report the narrative experiences of refugee claimant families who were denied health care services in Montreal following June 2012, (2) describe the predominant barriers to accessing health care services and understanding their impact using thematic analysis and (3) derive concrete recommendations for child health care providers to improve access to care for refugee claimant children.
Eleven parents recruited from two sites in Montreal participated in semi-structured interviews designed to elicit a narrative account of their experiences seeking health care. Interviews were recorded, transcribed, coded using NVivo software and subjected to thematic analysis.
Thematic analysis of the data revealed five themes concerning barriers to health care access: lack of continuous health coverage, health care administrators/providers' lack of understanding of Interim Federal Health Program coverage, refusal of services or fees charged, refugee claimants' lack of understanding about health care rights and services and language barriers, and four themes concerning the impact of denial of care episodes: potential for adverse health outcomes, psychological distress, financial burden and social stigma.
We propose eight action points for advocacy by Canadian paediatricians to improve access to health care for refugee claimant children in their communities and institutions.
2012年6月，加拿大政府大幅限制了临时联邦健康计划的范围，该计划此前一直为难民申请者的医疗保健需求提供覆盖。魁北克省政府决定通过省级健康计划来补充覆盖范围。尽管如此，我们推测蒙特利尔的难民申请者儿童在获取基本医疗保健方面仍将继续面临重大困难。
（1）报告2012年6月后在蒙特利尔被拒绝医疗服务的难民申请者家庭的叙述经历；（2）使用主题分析描述获取医疗服务的主要障碍并了解其影响；（3）为儿童医疗保健提供者提出具体建议，以改善难民申请者儿童的医疗服务获取情况。
从蒙特利尔的两个地点招募了11位家长，他们参与了半结构化访谈，旨在引出他们寻求医疗保健经历的叙述。访谈进行了录音、转录，使用NVivo软件进行编码，并进行了主题分析。
对数据的主题分析揭示了与医疗服务获取障碍相关的五个主题：缺乏持续的健康覆盖、医疗保健管理人员/提供者对临时联邦健康计划覆盖范围缺乏了解、服务拒绝或收费、难民申请者对医疗保健权利和服务缺乏了解以及语言障碍，以及与拒绝护理事件影响相关的四个主题：不良健康结果的可能性、心理困扰、经济负担和社会耻辱。
我们提出了八点行动建议，供加拿大儿科医生进行宣传，以改善其社区和机构中难民申请者儿童的医疗服务获取情况。
