Access to Healthcare Flashcards
Access to Healthcare
- Access to healthcare is a key social determinant of health
- While focusing only on access is a limited approach, this doesn’t mean access isn’t important
- Globally focus has still been on increasing access to healthcare
- E.g. Canada’s global maternal health programming → almost exclusively about increasing access to medical care during pregnancy and childbirth – neglects social determinants of health during pregnancy and throughout life course
- Need to go beyond ‘access’ and look specifically at inequalities in access
- Who can access?
- What barriers prevent access?
Social Location Contexts
- Oppressions within intersecting SDOH contexts (community, group, family, individual, etc.)
- Social location-related oppressions that impact health status and access to are across the lifecourse
Point-of-Care Contexts
- Oppressions within health care access contexts
- Oppressive, institutionally embedded practices and policies that create health-damaging access barriers at point-of-care
Systemic Contexts
- Oppressions within macro-politics, cultural, social and economic contexts
- Structural violence that creates and sustains oppressions in health outcomes and access to care
- Oppressive public policies, oppressive research practices
Publicly Funded Insurance Schemes
-funded through public dollars (taxes) and administered by the state
Private Insurance Schemes
-funded by private corporations and motivated by profit – plans are purchased by employers and individuals
Is healthcare a right? Or a commodity?
Canada’s healthcare system – provision of healthcare through social policy
Decrease the role of income in determining access Yet…..income remains key determinant of access
Medical Care Act (1966)
- Principles guiding cost-sharing health care for provinces for the first-time
- Non-profit operation by public authority
- Universal and equal access
- Comprehensive health insurance plans
- Portable coverage
Canada Health Act (1984)
- Penalize provinces allowing extra- billing→burden of which was felt by the poor
- Ensure conformity and consistency
- Embedded values of equity and right to healthcare
Income and Cost-related Barriers
- Despite publicly funded healthcare, income/costs remains a barrier
- Transportation costs, prescription and over-the-counter medications; child care; lost time from work
- When people can’t afford to follow up on treatment labelled ‘non-compliant’
- Income/cost intersects with various social positions
- People with disabilities especially vulnerable
- Nearly twice as likely to be living in poverty
- Additional costs
- Erosion of social safety net
Social Location Contexts
- We’ve already examined how social location shapes health – including through social exclusion
- Not based on identities – but how these identities are situated in social contexts
- i.e. race and racism; gender and sexism; sexuality and heteronormativity/homophobia; Indigenous ancestry and colonialism
- Social locations intersect – as do their impacts on environments, access to resources, etc.
Geography and Access to Care
- Geography as broad determinant of health (e.g. environmental racism) but also specifically affects access to care
- Norther communities (largely Indigenous), rural communities, Eastern Canada
- Decreased access to primary care, specialized care, preventative care
- Greater economic vulnerability
- Transportation availability: cost in time and money, and effects of health
Case Study: Marya’s Healthcare Costs
-Rurality tax per year: $2549
-Long distance phone calls = $120/year
-Return trip gas and mileage = $175 x7
-Lost wages due to travel = $172 x7
-Excess burden of uninsured health care needs: $560
-Braces, wrist and ankle supports, wax treatments,
drug costs
-Total Access Burden Cost for Marya’s Family = 3109
Point-of-Care Contexts
- Homophobia, sexism, racism
- Discrimination, gatekeeping and individualized blame
- Effects diagnosis, treatment, and continuation of care
- Culturally appropriate healthcare not always available or seen as legitimate
- Negative interactions with institutions (healthcare or others) may affect willingness to seek care
- E.g. Indigenous peoples and immigrants who have experienced racism in healthcare, or with child welfare workers
Medicalization is…
a process by which problems that were previously thought of as non-medical become defined and treated as medical (only) problems
