21 Health professionals’ experiences with uninsured children in Québec: A qualitative study in paediatric settings
Notice bibliographique
Résumé
Abstract Background The 2021 Bill 83 (PL83) aimed to provide provincial public health insurance (RAMQ) to previously uninsured migrant children in Quebec. However, many children remain uninsured, posing ethical challenges for healthcare professionals that have yet to be thoroughly examined. Objectives This study sought to explore healthcare professionals' experiences with uninsured children, focusing on practical and ethical issues arising from lack of insurance. Design/Methods This qualitative study, adopting a comprehensive paradigm focused on participants' subjectivity, included semi-structured interviews with healthcare professionals. These participants were recruited through purposive and snowball sampling at Quebec's two largest paediatric hospitals, one of which had a clinic for recently migrated children. Interview topics included clinical experiences with uninsured children, the impact of lack of insurance, and strategies for overcoming barriers. Interviews were fully transcribed, and thematic analysis using inductive coding (NVivo) revealed key themes. Results Between January and October 2024, 25 participants (52% physicians, 20% nurses, 20% social workers) were recruited. Analysis identified four main themes:Organizational and systemic factors contribute to a lack of RAMQ coverage, especially for eligible newborns whose parents do not have RAMQ coverage (uninsured migrants or asylum)Quebec’s healthcare system relies on the possession of RAMQ; its absence leads to significant challenges, including hospital bills, difficulties accessing primary healthcare services or physicians refusing consultations. It affects children insured by the Interim Federal Health Program (IFHP) who do not have RAMQ.Emergency departments (EDs) become the only option for parents seeking medical care for their children. EDs are not designed to respond to the healthcare and psychosocial needs of these marginalized populations. When EDs have access to teams dedicated to caring for migrants, these teams are also limited in their capacity to respond due to high demand and lack of resources.Participants expressed frustration and a sense of injustice toward barriers children without RAMQ face. Ethical challenges prompt professionals to find solutions to provide equitable care, such as unpaid work, longer consultations time to guide parents in navigating the system, and adapting treatments to financial limitations and life circumstances. Participants expressed helplessness, as some solutions exist but remain limited compared to the complex needs of these marginalized populations. Conclusion Insights from healthcare professionals highlight strategies used to mitigate the impact of lack of RAMQ on children’s healthcare. Potential systemic solutions include presumed eligibility based on residency proof, educating the healthcare workforce, and improving access to primary care.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,008 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,019 | 0,010 |
| Communication savante | 0,006 | 0,002 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».