Abstract
The aim of the present doctoral thesis is the health provision to immigrants living in Greece with or without their civil rights. Using a socio-psychological perspective of thematic content analysis, discursive and rhetorical psychology, this thesis explores the social representations of physicians working in different work contexts for a series of issues that have to do with the health system, within which health provision takes place as well as the ways physicians perceive health provision towards immigrant patients. Since health provision does not take place in a void, rather within a system that is influenced by certain notions and philosophies of health that take form within certain organizational and social structures, the present doctoral thesis focuses on the exploration of the views of physicians regarding the notion of health and its provision within the health system, as well as the exploration of the ways physicians perceive immigrant patients and their health provision. T ...
The aim of the present doctoral thesis is the health provision to immigrants living in Greece with or without their civil rights. Using a socio-psychological perspective of thematic content analysis, discursive and rhetorical psychology, this thesis explores the social representations of physicians working in different work contexts for a series of issues that have to do with the health system, within which health provision takes place as well as the ways physicians perceive health provision towards immigrant patients. Since health provision does not take place in a void, rather within a system that is influenced by certain notions and philosophies of health that take form within certain organizational and social structures, the present doctoral thesis focuses on the exploration of the views of physicians regarding the notion of health and its provision within the health system, as well as the exploration of the ways physicians perceive immigrant patients and their health provision. The way this thesis is structured as well as the configuration and the contents of the chapters that follow, aim to feature this triple research goal, by dividing the thesis in three parts. The first theoretical part (chapters 1, 2, 3) are dedicated to the context of health provision. Starting from the different philosophies that influence the health system, the first chapter focuses on two completely opposite theoretical views of health: the bio-medical health model and the holistic health model. A short historical retrospect follows in the second chapter where the main forms of the health system in Greece are presented from its first formation until today. The third chapter focuses on immigrants and the need of health provision within the current socioeconomic context. Using demographic data from European countries as well as Greece, the first bibliographical review of research on health towards immigrants is conducted, in order to highlight the reasons that dictate the need for research in this field. The second part of the thesis (chapters 4 and 5) focuses solely on the current thesis and the way that it was conducted, presenting its theoretical and methodological context. Social representations theory is the theoretical context of this thesis. This theory focuses on the historic, social and ideological context of health provision, elements that exist within the approach of this thesis and have been applied for researching issues of health in international studies that created research questions for xv further exploration. Within the context of this approach a short review of studies regarding social representations of health, health systems and immigrants as patients is attempted. Chapter 5 addresses the aims of this research as well as the theoretical and analytical methodology of the data (principles of thematic content analysis, discursive and rhetorical psychology). The data of the thesis derived from 40 interviews of physicians who work in the public health sector, the private health sector, non governmental organizations (N.G.Os) and jail. In the third part of the thesis (chapters 6, 7, 8, 9 and 10) the results of the analysis of the interviews are presented based on the analysis of segments of the physicians’ discourse, that feature their social representations regarding a) health b) the health system c) migration, d) the conditions under which health is provided to immigrant patients and e) immigrants as patients. The presentation and discussion of the segments is conducted using a combination of the principles of discursive psychology, rhetorical psychology and the theory of social representations. In accordance with the principles of discourse analysis, the participants in this study through their discourse and use of social representations have “created” different social realities for health provision and immigrant patients. In this context health provision, influenced from the social representation of health as human right, was discussed as a basic human right that should be given to any human being that needs it and therefore not providing health to an immigrant patient is a violation of his or her basic human right that leads to social exclusion. At the same time discourse influenced from the social representation of health as a product for sale available only to those who can afford it, represent immigrant patients as potential buyers of the product that is health. In accordance with the basic premises of the present doctoral thesis the discourse of the participants is characterized by ideological dilemmas with the opposing social representations informing each other. Regarding the notion of immigration, the conditions under with health is administered to immigrant patients and immigrants as patients themselves, it was found that participants discourse was influenced by the ideology of ethnocentrism, and the notion of citizenship to represent the immigrant as “the other” attributing to the immigrants the responsibility of their health the treatment of their health problems and also representing them as a “burden” to the Greek health system. The alternative discourse regarding immigration and immigrants drew from the promotion of health as a basic human right that transcends beyond national discriminations, ethnocentrism and the ideology of profit in health provision and perceives each human being equal regarding the right to health.
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