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Mengesha Z, Weber D, Smith M, Harris P, Haigh F. 'Fragmented care': Asylum seekers' experience of accessing health care in NSW. Health Promot Int 2023; 38:daad123. [PMID: 37864803 DOI: 10.1093/heapro/daad123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023] Open
Abstract
Medicare is central to accessing health care in Australia, yet many asylum seekers are ineligible for this scheme. In NSW, Medicare ineligible asylum seekers have some access to public health care under the Medicare Ineligible Asylum Seekers - Provision of Specified Public Health Services policy. This policy was updated in November 2020 to clarify services where a fee waiver applies for asylum seekers without Medicare. We examined the experiences of Medicare ineligible asylum seekers in accessing health care in New South Wales (NSW) in light of the revised policy. Employing qualitative methods, we conducted semi-structured interviews with asylum seekers (n = 7) and service providers (n = 6) in South Western Sydney. The interviews were analysed using thematic analysis and the socio-ecological model was used to interpret the data. Participants identified that chronic and mental health conditions are the main health issues for asylum seekers. Factors across the four levels of the socio-ecological model were identified as influencing the health care of asylum seekers, including a lack of awareness about health care rights at the individual level, support from relatives and friends at the interpersonal level, providers' lack of awareness of fee waivers at the organizational level and limited access to primary health care at the policy level. The results imply that Medicare ineligible asylum seekers in NSW do not have optimal access to health care which may worsen existing health disparities. Educational initiatives that improve service providers' and asylum seekers' awareness of the revised policy are needed to improve asylum seeker health equity in NSW.
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Affiliation(s)
- Zelalem Mengesha
- Centre for Health Equity Training, Research & Evaluation (CHETRE); UNSW Australia Research Centre for Primary Health Care & Equity; A Unit of Population Health; member of the Ingham Institute, Sydney, NSW, Australia
| | - Danielle Weber
- NSW Refugee Health Service, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Mitchell Smith
- NSW Refugee Health Service, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Patrick Harris
- Centre for Health Equity Training, Research & Evaluation (CHETRE); UNSW Australia Research Centre for Primary Health Care & Equity; A Unit of Population Health; member of the Ingham Institute, Sydney, NSW, Australia
| | - Fiona Haigh
- Health Equity Research Development Unit, UNSW Sydney; A unit of Clinical Services Integration and Population Health, Sydney Local Health District, Sydney, NSW, Australia
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Marjadi B, Flavel J, Baker K, Glenister K, Morns M, Triantafyllou M, Strauss P, Wolff B, Procter AM, Mengesha Z, Walsberger S, Qiao X, Gardiner PA. Twelve Tips for Inclusive Practice in Healthcare Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4657. [PMID: 36901666 PMCID: PMC10002390 DOI: 10.3390/ijerph20054657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
This paper outlines practical tips for inclusive healthcare practice and service delivery, covering diversity aspects and intersectionality. A team with wide-ranging lived experiences from a national public health association's diversity, equity, and inclusion group compiled the tips, which were reiteratively discussed and refined. The final twelve tips were selected for practical and broad applicability. The twelve chosen tips are: (a) beware of assumptions and stereotypes, (b) replace labels with appropriate terminology, (c) use inclusive language, (d) ensure inclusivity in physical space, (e) use inclusive signage, (f) ensure appropriate communication methods, (g) adopt a strength-based approach, (h) ensure inclusivity in research, (i) expand the scope of inclusive healthcare delivery, (j) advocate for inclusivity, (k) self-educate on diversity in all its forms, and (l) build individual and institutional commitments. The twelve tips are applicable across many aspects of diversity, providing a practical guide for all healthcare workers (HCWs) and students to improve practices. These tips guide healthcare facilities and HCWs in improving patient-centered care, especially for those who are often overlooked in mainstream service provision.
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Affiliation(s)
- Brahmaputra Marjadi
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Joanne Flavel
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Stretton Health Equity, Stretton Institute, School of Social Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Kirsten Baker
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Australian Research Consortium in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kristen Glenister
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Department of Rural Health, The University of Melbourne, Wangaratta, VIC 3677, Australia
| | - Melissa Morns
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Mel Triantafyllou
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia
| | - Penelope Strauss
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6009, Australia
| | - Brittany Wolff
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Psychological Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| | - Alexandra Marie Procter
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Zelalem Mengesha
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- Centre for Primary Health Care and Equity, The University of New South Wales, UNSW, Sydney, NSW 2025, Australia
| | - Scott Walsberger
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- ACON, Surry Hills, NSW 2010, Australia
| | - Xiaoxi Qiao
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Paul A. Gardiner
- Diversity, Equity and Inclusion Special Interest Group, Public Health Association of Australia, Deakin, ACT 2600, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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Angeles MR, Crosland P, Hensher M. Challenges for Medicare and universal health care in Australia since 2000. Med J Aust 2023; 218:322-329. [PMID: 36739106 DOI: 10.5694/mja2.51844] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening. STUDY DESIGN Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 - 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 - 14 August 2021. Program-, intervention- or provider-specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded. DATA SOURCES MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites. RESULTS The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out-of-pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system. CONCLUSIONS A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.
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Affiliation(s)
| | - Paul Crosland
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Martin Hensher
- Menzies Institute for Medical Research, the University of Tasmania, Hobart, TAS
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Nkhoma G, Lim CX, Kennedy GA, Stupans I. Attitudes and Knowledge of, and Preferences for Learning about Cultural Competence: A Study of Pharmacy Students from One Australian Pharmacy Program. PHARMACY 2022; 10:66. [PMID: 35736780 PMCID: PMC9230435 DOI: 10.3390/pharmacy10030066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/08/2022] [Accepted: 06/16/2022] [Indexed: 02/01/2023] Open
Abstract
Culturally and linguistically diverse populations, particularly asylum seekers, face challenges in accessing healthcare services. Pharmacists need to be capable of identifying and responding appropriately to the needs of diverse population groups. The aims of this study were to clarify student pharmacists’: knowledge of, and attitudes to, asylum seekers; their understanding of themselves with regard to cultural competence; their exposure to culturally and linguistically diverse clinical settings; their potential receptivity to learning opportunities directed towards cultural competence; and the extent to which they interpreted the current curriculum as improving their cultural competence. Pharmacy students’ viewpoints and perspectives were essential as emerging pharmacy professionals. This study employed mixed methods and convenience sampling. There were no significant (p > 0.05) associations between demographics and any of the survey items. Five themes emerged from the interviews: namely, exposure, formal vs. informal, positive views, conflict, and sufficiency. Pharmacy curriculum should ideally provide sufficient knowledge to meet culturally diverse healthcare consumers’ needs, especially asylum seekers. The most efficacious models for teaching cultural competence are as yet still undetermined. Interactive learning in cultural competence was recommended as essential.
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Affiliation(s)
- Gloria Nkhoma
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
| | - Chiao Xin Lim
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
| | - Gerard A. Kennedy
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
- Institute of Health and Wellbeing, Federation University, P.O. Box 663, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, 145 Studley Rd., Heidelberg, VIC 3084, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, STEM College, Royal Melbourne Institute of Technology, Bundoora, Melbourne, VIC 3083, Australia; (C.X.L.); (G.A.K.); (I.S.)
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Policies and initiatives/programs that promote health and self-care in asylum seekers living in high income countries: a narrative review. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2021. [DOI: 10.1108/ijhrh-09-2021-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace.
Design/methodology/approach
Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives.
Findings
Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research.
Originality/value
This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace.
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