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
Medicalization facts…
- Not inherently good or bad
- Medicalization can lend legitimacy, can lead to new and effective solutions
- BUT over-medicalization can lead to an ignoring of social determinants of health: treatment of social problems through medical treatment
- E.g. the psychiatrization of oppression
Access & Health Research
- Access also determined by priorities in health research
- What treatments are seen as legitimate and effective?
- What illnesses and conditions are researched?
Whose health is prioritized in research?
- HIV/AIDS crisis & homophobia
- Exclusion of women from clinical trials
Whose health has been sacrificed in the name of
research?
- Testing of contraceptive pill on Puerto Rican women in 1950s
- Tuskegee Syphilis Experiment conducted on rural African-American men 1930s-1970s
10/90 gap
-10% or less of world’s health research spending is directed at conditions responsible for 90% of global burden of disease
Diseases that Effect the Poor
- not seen as commercially attractive investment opportunities
- Private, for-profit firms, mainly pharmaceutical firms substantially outspend governments worldwide on health research – issues of accountability
- Who has access to treatment once it is developed?
Systemic Contexts
Inequities in SDOH and at point-of-care are created and sustained by systemic context of oppressions
Structural Violence
systematically produced, sustained and
avoidable inequities in access to the good, services, resources, and opportunities of society (related to social exclusion)
Social Murder
- When structural violence causes death
- Acephie and Chouchou
- Brian Sinclair
- Institutions can perpetuate structural violence by structuring access
- Examples of social exclusion:
- Hospitalization as marker of social class
- Early dental caries as a marker of childhood suffering -Early death as maker of classism and racism
