Understanding the delivery of health and welfare to diverse populations


Healthcare provision is a core part of the welfare state, although one that has been much neglected in studies of welfare systems despite Moran’s (2002) argument that healthcare provision should be central to our understanding of welfare provision. This book focuses on the ways in which residents living in superdiverse neighbourhoods address their health concerns. We will demonstrate that individuals use resources from across the welfare state, but that access to healthcare is critical to the approaches adopted. Thus in this chapter we examine the relationship between healthcare provision and diversity and how this has developed in the post-war period. While European healthcare systems share the common ideal of universal healthcare accessible to all, the way that this goal was achieved varies greatly from country to country, reflecting to some extent the namre of the national welfare regime, although despite being a key aspect of welfare, healthcare was not taken into account by Esping-Andersen (1990). Different European countries’ healthcare systems are far from unified, with significant variation in evidence regarding how services are coimnissioned, configured, delivered, evaluated and financed. In the context of the European Union, healthcare services have remained a national responsibility, with variation in both how they are organised and the relative responsibility of municipal, regional and national authorities in that organisation, as well as variation in how parallel charitable provision works alongside the public health system. European treaties have confirmed healthcare provision to be the responsibility of individual member states, despite such provision depending on the movement of people, goods and services that are subject to European Law (Legido-Quigley & Nolte, 2008).

The variation in how European member states organise their healthcare provision is evident in the different systems of financing, of referrals and pathways to care, and links with social care, to name but a few (Chakrabarti, 2013). While European countries’ health sendee configuration, organisation and development vary greatly, a common assumption has been that healthcare providers and healthcare users would share a language and a cotmnon culture. The relative immobility of populations after the redistribution of refugees post-World War II and before cheap air travel became widely available in the 1990s meant that during the second half of the twentieth century when national (or federal) healthcare systems were being established, this assumption was, for the most part, workable. In the UK from the 1970s with the growing acknowledgement of multiculturalism and then across Europe from the 1990s onwards, the widespread movements that characterise the age of migration (Miller & Castles, 2009) showed up the limitations of these assumptions for an increasingly diverse population of patients. This chapter characterises how European healthcare systems have responded to the increase in migration-related diversity. We are interested in the variation of responses between European settings, as well as the absence of change to how healthcare is commissioned, configured and delivered in response to increasing levels of migration-related diversity.

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