Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada.
BMJ Open. 2021 Aug 5;11(8):e047597. doi: 10.1136/bmjopen-2020-047597.
To evaluate impacts of a residency-based waiting period for health insurance coverage on lived experiences of health and settlement for im/migrant women in British Columbia, Canada.
The IRIS study is a mixed-methods, community-based, qualitative evaluation of recently arrived im/migrant women's access to sexual and reproductive care. In-depth, semistructured interviews were conducted by trained multilingual and multicultural interviewers with lived migration experience in the participant's preferred language.
Metro Vancouver, British Columbia, Canada from July 2018 to January 2020.
Data collected from community focus groups (four groups, n=29) of both service providers and im/migrant women was used. Following this, qualitative interviews with service providers (n=10) and im/migrant women (n=47) were conducted. Eligible participants self-identified as women; were aged 18-49 and had arrived in Canada from another country. Eligible providers were employed in the health, social or legal sectors working with im/migrant women.
The wait period resulted in mistrust and internalised stigma for racialised im/migrant women, for whom the policy resulted in feeling 'undeserving' of care. Resulting administrative burden produced delays and unmet need for care, particularly related to sexual and reproductive healthcare and children's health. Unexpected costs meant difficult choices between survival and care. Negative health outcomes included the inability to family plan, difficulties during pregnancy, as well as hardships related not being able to seek help for sick children. Community-based organisations provided support in many areas but could not fill all gaps produced by this policy.
Findings highlight severe, yet commonly overlooked, health inequities produced by a mandatory health coverage wait period within a purportedly 'universal' healthcare system. Health system policies such as mandatory 'waiting periods' produce discriminatory and inequitable outcomes for im/migrant women. Policy reforms towards full 'healthcare for all' are urgently needed to affirm the health and human rights of all im/migrants.
评估医疗保险覆盖的居住等待期对不列颠哥伦比亚省（加拿大）移民妇女的健康和定居生活经历的影响。
IRIS 研究是一项混合方法、以社区为基础的、对最近抵达的移民妇女获得性和生殖保健的机会的定性评估。受过培训的多语言和多元文化访谈者以参与者首选的语言对具有移民生活经历的参与者进行深入的半结构化访谈。
加拿大不列颠哥伦比亚省大温哥华地区，2018 年 7 月至 2020 年 1 月。
使用社区焦点小组（四组，n=29）的数据，这些小组的参与者既有服务提供者，也有移民妇女。之后，对服务提供者（n=10）和移民妇女（n=47）进行了定性访谈。符合条件的参与者自我认定为女性；年龄在 18-49 岁之间，从另一个国家抵达加拿大。符合条件的服务提供者在从事移民妇女工作的卫生、社会或法律部门工作。
等待期导致了种族化的移民妇女的不信任和内化的耻辱感，对她们来说，该政策导致了感觉“不值得”获得护理。由此产生的行政负担导致了护理的延迟和未满足的需求，特别是与性和生殖保健以及儿童健康有关。意想不到的费用意味着在生存和护理之间做出艰难的选择。负面的健康结果包括无法计划生育、怀孕困难，以及由于无法为生病的孩子寻求帮助而带来的困难。社区组织在许多领域提供支持，但无法填补这一政策造成的所有空白。
研究结果突出了在一个据称“普遍”的医疗保健系统中，强制性医疗保险覆盖等待期所产生的严重但通常被忽视的健康不平等现象。健康系统政策，如强制性“等待期”，对移民妇女产生歧视性和不平等的结果。迫切需要进行政策改革，实现全民“医疗保健”，以确认所有移民的健康和人权。
