Abstract
Introduction: Descriptive data indicate a high burden of chronic illness among immigrant women in Switzerland. Little is known about how immigrant women with chronic illnesses experience healthcare services. This paper presents a methodological approach theoretically informed by Sen's capability approach and Levesque's framework of access to healthcare to study patient-reported experiences (PREs) of Swiss healthcare services among immigrant women with chronic conditions.Methods: We conducted 48 semi-structured qualitative interviews in Bern and Geneva with Turkish (n = 12), Portuguese (n = 12), German (n = 12), and Swiss (n = 12) women. Participants were heterogenous in age, length of stay, SES, and educational attainment, illness types and history. We also conducted semi-structured interviews with healthcare and social service providers (n = 12). Interviewed women participated in two focus group discussions (n = 15). Interviews were transcribed verbatim and analyzed using Atlas.ti software, based on Gale et al.'s framework approach. Findings informed three stakeholder dialogues in which women as well as healthcare providers and policymakers from various territorial levels participated.Results: Our methodological approach succeeded in integrating women's perspectives—from initial data collection in interviews to identify issues, focus group discussions to increase rigor, and stakeholder dialogues to develop tailored recommendations based on PREs.Discussion: This is one of the first studies in Switzerland that used PREs to research healthcare services and healthcare needs among immigrant women with chronic illnesses. This paper provides new insights on how to better understand existing challenges and potentially improve access to and quality of care.
Highlights
Descriptive data indicate a high burden of chronic illness among immigrant women in Switzerland
In using the capability approach, we focus on the interplay between the utilization of services and healthcare service infrastructure
We will present selected first results: [1] on the recruitment of women with chronic illness and immigration experience, [2] the need to consider strategies and resources used by patients in dealing with healthcare services, and [3] the content of the practice recommendations developed during the stakeholder dialogues and further steps
Summary
Descriptive data indicate a high burden of chronic illness among immigrant women in Switzerland. The Swiss healthcare system is characterized by a compulsory basic health insurance scheme, with similar insurance premiums for all, and subsidies for the poorer inhabitants, and are accompanied by further patient payments in forms of an annual excess (the deductible) and a charge of 10% of all basic costs that exceed the excess (excluded are some expensive treatments and hospital interventions). The complementary insurance is to cover additional treatment dimensions and to improve standards of rooms and services in case of hospitalization. These basic insurance finances around 50% of the costs of the health system. The other 50% is financed by income-based taxes (in particular for hospital infrastructures, civil servants in the health system, and public health services)
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