Accès aux soins de santé : expériences de migrants sans assurance maladie à Montréal, Canada
Improving access to care is an essential element in the performance of any health system and a major concern for health managers and decision-makers. Access to care for migrant populations results a number of challenges. The limitations of studies on access to health care for migrants, especially without health insurance, led us to carry out this research. This study purposes to describe the situation of access to health care for migrants without health insurance in the Montreal city. This qualitative study used semi-structured interview guides from sixteen (16) participants. The contrast sampling design was applied to our study population in order to have one or two typical cases per community group (migrant) as suggested by Pires. The access to care situation was described according to the five areas of Levesque's conceptual framework and new information were emerged from this thematic analysis. Access to health care for migrants without health insurance is considered more critical in three areas of the framework including availability, abortion and relevance. Indeed, even if there are no difficulties in identifying health services or accessing them physically, there are obstacles that are linked to care. The lack of health insurance, the direct costs of care, the unavailability of specialized doctors, poverty are the main constraints observed in this study. Other barriers, such as long care and diagnosis delays, non-continuity and adherence to care, significantly reduce the appropriateness of care. These constraints to care access might impact negatively on the target groups physical and mental health, as well as huge expenditures in hospital emergency departments.
Recherche qualitative Access to health care Migrant without health insurance Experiences Montreal Health services Qualitative research