Dossier n. 151/2007 [Abstract] "Do I have to wait here?". Ethnographic research on access paths to health services in Bologna

The report is part of the project “Inequalities: generative mechanisms and identification of possible interventions” promoted by the Regional Agency for Health and Healthcare of Emilia-Romagna and co-financed by the Italian Health Ministry.

The research analyses organizational processes and practises that start (or that can start) inequalities in access to health services. In particular, the relationship between users and health organization is studied, considering the interlacement of variables - not only clinical, epidemiological and economic ones but also socio-cultural and psycho-social variables - that generate conditions of inequity when users and health professionals, social groups and health organizations meet.

The identification of these mechanisms is aimed at implementing actions by the local and regional governments to encourage a culture oriented toward a “citizenship of differences” principle and to promote participation in health policies choices.

To decide the settings for the survey, the distinction between services for specific users and universalistic services was considered. Between February and July 2004 the following services in Bologna were studied, each for a working week period:

• Service A, for irregular immigrants; it offers general care and basic pharmaceutical care;
• Service B, for foreign (regular and irregular) women and children just arrived in Italy; it offers gynaecological, paediatric and general visits and psychological help;
• centre for booking medical visits and exams (CUP);
• emergency ward in a city hospital;
• 2 advisory centres.

Considering these different access points to the National Health System, the different care paths offered by the services are studied, in particular focusing on the initial meeting as fundamental in influencing the interaction between the organization and its users.

 Data were mainly collected through direct observation of some health professionals and through interviews. Original speeches of people met in the services, descriptions of situations and specific episodes, interpretations by the observer develop in the Chapters.

 The final Chapter analyses the network of health services, focusing in particular on the most common organizational processes and dynamics, on their influence on users’ access paths, on how these processes determine the construction and the everyday reproduction of some inequalities.