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The gap between entitlement and access to healthcare: An analysis of “candidacy” in the help-seeking trajectories of asylum seekers in Montreal

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  • Chase, Liana E.
  • Cleveland, Janet
  • Beatson, Jesse
  • Rousseau, Cécile

Abstract

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.

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  • Chase, Liana E. & Cleveland, Janet & Beatson, Jesse & Rousseau, Cécile, 2017. "The gap between entitlement and access to healthcare: An analysis of “candidacy” in the help-seeking trajectories of asylum seekers in Montreal," Social Science & Medicine, Elsevier, vol. 182(C), pages 52-59.
    • Handle: RePEc:eee:socmed:v:182:y:2017:i:c:p:52-59
    DOI: 10.1016/j.socscimed.2017.03.038
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    References listed on IDEAS

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    1. Vanthuyne, Karine & Meloni, Francesca & Ruiz-Casares, Monica & Rousseau, Cécile & Ricard-Guay, Alexandra, 2013. "Health workers' perceptions of access to care for children and pregnant women with precarious immigration status: Health as a right or a privilege?," Social Science & Medicine, Elsevier, vol. 93(C), pages 78-85.
    2. Cécile Rousseau & Youssef Oulhote & Mónica Ruiz-Casares & Janet Cleveland & Christina Greenaway, 2017. "Encouraging understanding or increasing prejudices: A cross-sectional survey of institutional influence on health personnel attitudes about refugee claimants' access to health care," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-14, February.
    3. Ruiz-Casares, Mónica & Rousseau, Cécile & Derluyn, Ilse & Watters, Charles & Crépeau, François, 2010. "Right and access to healthcare for undocumented children: Addressing the gap between international conventions and disparate implementations in North America and Europe," Social Science & Medicine, Elsevier, vol. 70(2), pages 329-336, January.
    4. Silove, D. & Steel, Z. & McGorry, P. & Drobny, J., 1999. "Problems Tamil asylum seekers encounter in accessing health and welfare services in Australia," Social Science & Medicine, Elsevier, vol. 49(7), pages 951-956, October.
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    1. Mackintosh, Nicola & Gong, Qian (Sarah) & Hadjiconstantinou, Michelle & Verdezoto, Nervo, 2021. "Digital mediation of candidacy in maternity care: Managing boundaries between physiology and pathology," Social Science & Medicine, Elsevier, vol. 285(C).
    2. Jaschke, Philipp & Kosyakova, Yuliya, 2020. "Does facilitated access to the health system improve asylum-seekers' health outcomes? : Evidence from a quasi-experiment," IAB-Discussion Paper 201907, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany].

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