Reference : Is universal healthcare truly universal? Socioeconomic and migrant inequalities in he...
Dissertations and theses : Doctoral thesis
Social & behavioral sciences, psychology : Sociology & social sciences
Is universal healthcare truly universal? Socioeconomic and migrant inequalities in healthcare
Paccoud, Ivana mailto [University of Luxembourg > Faculty of Humanities, Education and Social Sciences (FHSE) > Department of Social Sciences (DSOC) >]
University of Luxembourg, ​Esch-sur-Alzette, ​​Luxembourg
Docteur de l’Université du Luxembourg en Sciences Sociales
Leist, Anja mailto
Nazroo, James mailto
Chauvel, Louis mailto
Kornadt, Anna Elena mailto
Abel, Thomas mailto
[en] Social inequalities in healthcare ; economic, cultural and social capital ; Bourdieu ; Racism ; digital health
[en] Through the principle of Universal Healthcare Coverage, many governments across Europe and beyond seek to ensure that all people have equal access to good quality healthcare services, without facing a financial burden. Despite this, studies have highlighted persistent migrant and socio-economic inequalities in the use of healthcare services, and personal health records. Therefore, understanding the complex mechanisms that produce and maintain social inequalities in the effective use of healthcare services is thus an important step towards advancing equity in healthcare.

This thesis draws on Bourdieu's forms of capital (cultural, social, economic, and symbolic) to conceptualise and empirically test social inequalities related to healthcare. In doing so, it investigates the factors contributing to socioeconomic and migrant inequalities in the use, navigation and optimisation of healthcare services as well as personal health records. The three studies that make up this thesis empirically test these ideas through statistical modelling on population-based datasets as well as through the analysis of two cross-sectional surveys in Luxembourg and the Greater region.

The first study draws on the fifth wave of the Survey of Health, Aging, and Retirement in Europe (SHARE). It used cluster analysis and regression models to explain how the unequal distribution of material and non-material capitals acquired in childhood shape health practices, leading to different levels of healthcare utilisation in later life. The results suggest that although related, both material and non-material capitals independently contribute to health practices associated with the use of healthcare services.

The second study used data from a cross-sectional survey to investigate inequalities in the navigation and optimisation of healthcare services, taking into consideration the interplay between perceived racial discrimination and socioeconomic position. It revealed disparities between individuals born in Eastern Europe and the Global South and those born in Luxembourg which were explained by the experience of racial discrimination. It also found that the impact of discrimination on both health service navigation and optimisation was reduced after accounting for social capital.

The last study used data from a cross-sectional survey developed as a part of a collaborative project (INTERREG-APPS) to examine the socioeconomic and behavioural determinants in the intention to use personal health record in the Greater region of Luxembourg (Baumann et al., 2020). This study found that people’s desire and actual access to personal health electronic records is determined by different socioeconomic factors, while educational inequalities in the intention to regularly use personal health records were explained by the role of behavioural factors.

Taking together, the findings presented in this thesis thus show the value of mobilising Bourdieu’s theoretical framework to understand the mechanisms through which social inequalities in healthcare develop. In addition, it showed the importance of considering racial discrimination when examining migrant, and racial/ethnic differences in health.
Integrative Research Unit: Social and Individual Development (INSIDE) > PEARL Institute for Research on Socio-Economic Inequality (IRSEI)
Researchers ; Professionals ; Students ; General public

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