Paper short abstract:

Access to health care is often conceptualized using functionalist or systemic perspectives. We propose adding a constructivist perspective (Candidacy), showing how access is produced in negotiations between multiple agents, integrating macro, meso, and micro levels.

Paper long abstract:

Access to healthcare is a driving mechanism of inequity in health. Inequitable access occurs when access varies according to personal and social attributes rather than the need for care. For many people with severe mental health issues, social and health problems are inextricably connected, as are the needs for care.

Previously, access to care was viewed as a functional attribute of health services, ensuring that services can be accessed or utilised by those requiring care. Today, much of health service literature conceptualize access from a systemic perspective, including structural features of the health care system (e.g., availability, affordability, etc.) and features of individuals (predisposing and enabling factors).

In this paper, we study how access is perceived and experienced in the case of integrated health and social care services targeting people with severe mental illness. Building on one year of interviews and observations of interactions between health care professionals and people with mental illness, we explore how access is an arena for negotiating eligibility. These negotiations draw on categorizations from the policy level (e.g., the definition of the target group) and institutional norms (e.g., professional understandings), and individual perceptions of eligibility. Analytically, we apply the concept of ‘Candidacy’, arguing that this conceptual lens can enhance the anthropological analysis of the social processes of constructing access to care. Candidacy adds to the understanding of access highlighting the interrelated processes at policy, institutional, and micro level, which determine who is eligible for care and when.