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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Siersbaek, Rikke Ford, John Ní Cheallaigh, Clíona Thomas, Steve Burke, Sara |
| Abstract | Background People experiencing long-term homelessness face significant difficulties accessing appropriate healthcare at the right time and place. This study explores how and why healthcare performance management and funding arrangements contribute to healthcare accessibility or the lack thereof using long-term homeless adults as an example of a population experiencing social exclusion. Methods A realist evaluation was undertaken. Thirteen realist interviews were conducted after which data were transcribed, coded, and analysed. Results Fourteen CMOCs were created based on analysis of the data collected. These were then consolidated into four higher-level CMOCs. They show that health systems characterised by fragmentation are designed to meet their own needs above the needs of patients, and they rely on practitioners with a special interest and specialised services to fill the gaps in the system. Key contexts identified in the study include: health system fragmentation; health service fragmentation; bio-medical, one problem at a time model; responsive specialised services; unresponsive mainstream services; national strategy; short health system funding cycles; and short-term goals. Conclusion When health services are fragmented and complex, the needs of socially excluded populations such as those experiencing homelessness are not met. Health systems focus on their own metrics and rely on separate actors such as independent NGOs to fill gaps when certain people are not accommodated in the mainstream health system. As a result, health systems lack a comprehensive understanding of the needs of all population groups and fail to plan adequately, which maintains fragmentation. Policy makers must set policy and plan health services based on a full understanding of needs of all population groups. |
| Related Links | https://equityhealthj.biomedcentral.com/counter/pdf/10.1186/s12939-023-02029-8.pdf |
| Ending Page | 15 |
| Page Count | 15 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 14759276 |
| DOI | 10.1186/s12939-023-02029-8 |
| Journal | International Journal for Equity in Health |
| Issue Number | 1 |
| Volume Number | 22 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2023-10-17 |
| Access Restriction | Open |
| Subject Keyword | Public Health Health Promotion and Disease Prevention Health Services Research Health Policy Social Justice Equality and Human Rights Social Policy Health services accessibility Social exclusion Homelessness Health services administration Healthcare financing Organizational objectives Realist evaluation |
| Content Type | Text |
| Resource Type | Article |
| Subject | Health Policy Public Health, Environmental and Occupational Health |
| Journal Impact Factor | 4.5/2023 |
| 5-Year Journal Impact Factor | 4.7/2023 |
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