Could technology enable individuals with schizophrenia to access health care? The case of Ecuador

Purpose The purpose of this paper is to fill in the gaps in the literature regarding health-care access for individuals with schizophrenia, with a focus on Ecuador, and how technology can enable health-care access during the pandemic. Design/methodology/approach To achieve this aim, the author reviewed peer-reviewed articles in English and Spanish (using, among other sources, Medline and ProQuest), the Ecuadorian Constitution, law projects on mental health and suicide and government reports. Findings The consensus seems to be that the Ecuadorian health-care system has failed in its constitutional mandate to provide essential care for mentally ill patients, such as those suffering from schizophrenia. The data supporting the use of the internet and smartphone technology for delivering health services during the pandemic are extremely clear, but substantive governmental responses have been lacking. Research limitations/implications The major limitation of this study is the lack of data on schizophrenia in Ecuador and the use of technology. Originality/value This evaluation of the current literature on the effect of the pandemic on access to health care for patients suffering from mental illness is much-needed and should provide a welcome data source for research, practice and policymaking.

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“I was trying to speak to their human side” coping responses of Belgium’s undocumented migrants to barriers in health-care access

International Journal of Migration Health and Social Care ◽

10.1108/ijmhsc-05-2019-0051 ◽

2020 ◽

Vol 16 (3) ◽

pp. 253-267

Author(s):

Dirk Lafaut ◽

Gily Coene

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Access ◽

Access To Health Care ◽

Undocumented Migrants ◽

Care Providers ◽

Content Type ◽

Coping Responses ◽

Care Access ◽

Access To Health

Purpose Undocumented migrants experience major legal constraints in their health-care access. Little is known on how undocumented migrants cope with these limitations in health-care access as individuals. The purpose of this study is to explore the coping responses of undocumented migrants when they experience limited health-care access in face-to-face encounters with health-care providers. Design/methodology/approach The authors conducted multi-site ethnographic observations and 25 semi-structured in-depth interviews with undocumented migrants in Belgium. They combined the “candidacy model” of health-care access with models from coping literature on racism as a framework. The candidacy model allowed them to understand access to health care as a dynamic and interactive negotiation process between health-care workers and undocumented migrants. Findings Responses to impaired health-care access can be divided into four main strategies: (1) individuals can react with a self-protective response withdrawing from seeking further care; (2) they can get around the obstacle; (3) they can influence the health-care worker involved by deploying discursive or performative skills; or (4) they can seek to confront the source of the obstacle. Research limitations/implications These findings point to the importance of care relations and social networks, as well as discursive and performative skills of undocumented migrants when negotiating barriers in access to health care. Originality/value This study refines the candidacy model by highlighting how individuals respond on a micro-level to shifts towards exclusionary health policies and, by doing so dynamically, change provision of health-care services.

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Impact of restricting access to health care services on Syrian refugees in Jordan: evidence from cross-sectional surveys

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-08-2020-0068 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ibraheem Khaled Abu Siam ◽

María Rubio Gómez

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

Health Care Services ◽

Health Care Cost ◽

Syrian Refugees ◽

Cross Sectional ◽

Content Type ◽

Care Access ◽

Care Services

Purpose Access to health-care services for refugees are always impacted by many factors and strongly associated with population profile, nature of crisis and capacities of hosing countries. Throughout refugee’s crisis, the Jordanian Government has adopted several healthcare access policies to meet the health needs of Syrian refugees while maintaining the stability of the health-care system. The adopted health-care provision policies ranged from enabling to restricting and from affordable to unaffordable. The purpose of this paper is to identify the influence of restricted level of access to essential health services among Syrian refugees in Jordan. Design/methodology/approach This paper used findings of a cross-sectional surveys conducted over urban Syrian refugees in Jordan in 2017 and 2018 over two different health-care access policies. The first were inclusive and affordable, whereas the other considered very restricting policy owing to high inflation in health-care cost. Access indicators from four main thematic areas were selected including maternal health, family planning, child health and monthly access of household. A comparison between both years’ access indicators was conducted to understand access barriers and its impact. Findings The comparison between findings of both surveys shows a sudden shift in health-care access and utilization behaviors with increased barriers level thus increased health vulnerabilities. Additionally, the finding during implementation of restricted access policy proves the tendency among some refugees groups to adopt negative adaptation strategies to reduce health-care cost. The participants shifted to use a fragmented health-care, reduced or delayed care seeking and use drugs irrationally weather by self-medication or reduce drug intake. Originality/value Understanding access barriers to health services and its negative short-term and long-term impact on refugees’ health status as well as the extended risks to the host communities will help states that hosting refugees building rational access policy to protect whole community and save public health gains during and post crisis. Additionally, it will support donors to better mobilize resources according to the needs while the humanitarian actors and service providers will better contribute to the public health stability during refugee’s crisis.

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Forum: equity in access to health care. Introduction

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2008000500023 ◽

2008 ◽

Vol 24 (5) ◽

pp. 1159-1161 ◽

Cited By ~ 6

Author(s):

Claudia Travassos

Keyword(s):

Health Care ◽

Health Care Access ◽

Health Care Professionals ◽

Access To Health Care ◽

Health Care Systems ◽

Care Access ◽

Unethical Practices ◽

Access To Health ◽

Care Systems ◽

Equity In Access

The Introduction outlines this issue's special Forum on equity in access to health care, including three Articles and a Postscript. The Forum represents a continuation of the debates raised during a seminar organized by the Oswaldo Cruz Foundation in the city of Rio de Janeiro, Brazil, in 2006, in collaboration with UNICEF, UNDP, World Bank, the WHO Special Program for Research and Training in Tropical Diseases, and the United Nations Research Institute for Social Development. The authors approach health care access and equity from a comprehensive and contemporaneous perspective, introducing a new conceptual framework for access, in which information plays a central role. Trust is proposed as an important value for an equitable health care system. Unethical practices by health administrators and health care professionals are highlighted as hidden critical aspects of inequities in health care. As a whole, the articles represent a renewed contribution for understating inequalities in access, and for building socially just health care systems.

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Health Care Access Among Essential Critical Infrastructure Workers, 31 States, 2017-2018

Public Health Reports ◽

10.1177/0033354921996688 ◽

2021 ◽

pp. 003335492199668

Author(s):

Winifred L. Boal ◽

Jia Li ◽

Sharon R. Silver

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Access ◽

Access To Health Care ◽

Health Care Services ◽

Personal Health ◽

The Past ◽

Care Access ◽

Care Services ◽

Access To Health

Objectives Essential workers in the United States need access to health care services for preventive care and for diagnosis and treatment of illnesses (coronavirus disease 2019 [COVID-19] or other infectious or chronic diseases) to remain healthy and continue working during a pandemic. This study evaluated access to health care services among selected essential workers. Methods We used the most recent data from the Behavioral Risk Factor Surveillance System, 2017-2018, to estimate the prevalence of 4 measures of health care access (having health insurance, being able to afford to see a doctor when needed, having a personal health care provider, and having a routine checkup in the past year) by broad and detailed occupation group among 189 208 adults aged 18-64. Results Of all occupations studied, workers in farming, fishing, and forestry occupations were most likely to have no health insurance (46.4%). Personal care aides were most likely to have been unable to see a doctor when needed because of cost (29.3%). Construction laborers were most likely to lack a personal health care provider (51.1%) and to have not had a routine physical checkup in the past year (50.6%). Compared with workers in general, workers in 3 broad occupation groups—food preparation and serving; building and grounds cleaning and maintenance; and construction trades—had significantly lower levels of health care access for all 4 measures. Conclusion Lack of health insurance and underinsurance were common among subsets of essential workers. Limited access to health care might decrease essential workers’ access to medical testing and needed care and hinder their ability to address underlying conditions, thereby increasing their risk of severe outcomes from some infectious diseases, such as COVID-19. Improving access to health care for all workers, including essential workers, is critical to ensure workers’ health and workforce stability.

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Poverty, Welfare Reform and the "Culture of Wealth"

Practicing Anthropology ◽

10.17730/praa.29.4.7457136pw6830854 ◽

2007 ◽

Vol 29 (4) ◽

pp. 43-45 ◽

Cited By ~ 1

Author(s):

Merrill Singer

Keyword(s):

Health Care ◽

Health Care Access ◽

Partner Violence ◽

Access To Health Care ◽

Structural Violence ◽

Well Being ◽

Legal Rights ◽

True Nature ◽

Care Access ◽

Access To Health

An important shift has occurred in anthropology over the last 30 years. A notable expression of this change is seen in the contemporary anthropology of poverty. As dramatically contrasted with the anthropology of poverty of an earlier era, when the notion of a "culture of poverty" had currency within the discipline, current thinking has been significantly influenced by a structural approach that seeks to understand poverty and its health consequences in terms of what has been called "structural violence." Structural violence was introduced into the lexicon of anthropology to label relations of inequality that are so grave in their effect that they can be seen as a form of sanctioned violence (like the structuring of access to health care in terms of possession of health insurance or the exclusion from quality housing, or even any housing, on the basis of ethnicity and social class). Unlike street violence or intimate partner violence, both forms of physical harm that are criminalized, structural violence is legal and hence unpunished. Indeed, perpetrators, if they are corporate heads, may be rewarded with stock options and other perks that boost their salaries to obscene levels relative to the prevailing wage system in society generally. Structural violence has been publicly denied its true nature as a direct assault on the health and well-being of the poor and other marginalized populations because access to health care, access to housing, and access to food are not legal rights.

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Barriers to accessing health care services: A qualitative study of migrant construction workers in a Southwestern Indian city

10.21203/rs.3.rs-16097/v2 ◽

2020 ◽

Author(s):

Maija Santalahti ◽

Kumar Sumit ◽

Mikko Perkiö

Keyword(s):

Health Care ◽

Health Services ◽

Health Care Access ◽

Access To Health Care ◽

Health Care Services ◽

Construction Workers ◽

Access To Health Services ◽

Care Access ◽

Care Services ◽

Access To Health

Abstract Background: This study examined access to health care in an occupational context in an urban city of India. Many people migrate from rural areas to cities, often across Indian states, for employment prospects. The purpose of the study is to explore the barriers to accessing health care among a vulnerable group – internal migrants working in the construction sector in Manipal, Karnataka. Understanding the lay workers’ accounts of access to health services can help to comprehend the diversity of factors that hinder access to health care. Methods: Individual semi-structured interviews involving 15 migrant construction workers were conducted. The study applied theory-guided content analysis to investigate access to health services among the construction workers. The adductive analysis combined deductive and inductive approaches with the aim of verifying the existing barrier theory in a vulnerable context and further developing the health care access barrier theory. Results: This study’s result is a revised version of the health care access barriers model, including the dimension of trust. Three known health care access barriers – financial, cognitive and structural, as well as the new barrier (distrust in public health care services), were identified among migrant construction workers in a city context in Karnataka, India. Conclusions: Further qualitative research on vulnerable groups would produce a more comprehensive account of access to health care. The socioeconomic status behind access to health care, as well as distrust in public health services, forms focal challenges for any policymaker hoping to improve health services to match people’s needs.

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Access to health care for people with disabilities in rural Malawi what are the barriers?

10.21203/rs.2.13970/v1 ◽

2019 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

Lung Condition ◽

The Impact

Abstract Introduction People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside an impairment, on health care accessibility is explored. Method Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Questions, were recruited. People with cognitive impairments were excluded. Each of the selected participants underwent an individual in-depth interview and full recordings of these were then transcribed and translated. Findings and discussion Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Other barriers identified were distance to a facility, which was most hindering for the participants with a chronic lung condition, and unfavourable health seeking behaviour, whilst ‘time’ was found to be a common underlying factor. Attitudinal factors were not found to influence health care accessibility for this cohort. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

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Access to health care for people with disabilities in rural Malawi: what are the barriers?

10.21203/rs.2.13970/v3 ◽

2020 ◽

Author(s):

Josephine Harrison ◽

Rachael Thomson ◽

Hastings T. Banda ◽

Grace B. Mbera ◽

Stefanie Gregorius ◽

...

Keyword(s):

Health Care ◽

Health Care Access ◽

Access To Health Care ◽

People With Disabilities ◽

Randomised Control Trial ◽

Sensory Impairment ◽

Care Access ◽

Health Care Accessibility ◽

Access To Health ◽

The Impact

Abstract Background People with disabilities experience significant health inequalities. In Malawi, where most individuals live in low-income rural settings, many of these inequalities are exacerbated by restricted access to health care services. This qualitative study explores the barriers to health care access experienced by individuals with a mobility or sensory impairment, or both, living in rural villages in Dowa district, central Malawi. In addition, the impact of a chronic lung condition, alongside a mobility or sensory impairment, on health care accessibility is explored. Methods Using data from survey responses obtained through the Research for Equity And Community Health (REACH) Trust’s randomised control trial in Malawi, 12 adult participants, with scores of either 3 or 4 in the Washington Group Short Set (WGSS) questions, were recruited. The WGSS questions concern a person’s ability in core functional domains (including seeing, hearing and moving), and a score of 3 indicates ‘a lot of difficulty’ whilst 4 means ‘cannot do at all’. People with cognitive impairments were not included in this study. All who were selected for the study participated in an individual in-depth interview and full recordings of these were then transcribed and translated. Results Through thematic analysis of the transcripts, three main barriers to timely and adequate health care were identified: 1) Cost of transport, drugs and services, 2) Insufficient health care resources, and 3) Dependence on others. Attitudinal factors were explored and, whilst unfavourable health seeking behaviour was found to act as an access barrier for some participants, community and health care workers’ attitudes towards disability were not reported to influence health care accessibility in this study. Conclusions This study finds that health care access for people with disabilities in rural Malawi is hindered by closely interconnected financial, practical and social barriers. There is a clear requirement for policy makers to consider the challenges identified here, and in similar studies, and to address them through improved social security systems and health system infrastructure, including outreach services, in a drive for equitable health care access and provision.

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Determinants of Health Care Access After Spinal Cord Injury

Journal of Applied Rehabilitation Counseling ◽

10.1891/0047-2220.44.2.11 ◽

2013 ◽

Vol 44 (2) ◽

pp. 11-17

Author(s):

Veronica Umeasiegbu

Keyword(s):

Health Care ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Health Care Access ◽

Access To Health Care ◽

Rehabilitation Counseling ◽

Care Access ◽

Access To Health ◽

Cord Injury ◽

Race Ethnicity

This paper presents a review of the literature examining determinants of access to health care among individuals with spinal cord injury (SCI). The literature shows that health insurance, race-ethnicity, income, age, gender, and residential location (rural/urban) are common themes discussed in the literature as factors that influence access to health care of persons with SCI. This review ends with discussion of implications for rehabilitation counseling research and practice.

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