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Open Access Highly Accessed Editorial

The hidden inequity in health care

Barbara Starfield

International Journal for Equity in Health 2011, 10:15  doi:10.1186/1475-9276-10-15

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Equity and the problem of legitimacy

Christine Loignon   (2011-06-10 09:45)  Universit�� de Sherbrooke email

I really appreciated reading the Starfield's editorial entitled "The hidden inequity in health care". As a sociologist, my scientific research in primary care leads me to consider the importance of the user point of view regarding the problem of legitimacy. Underserved patients I've met who experience both multiple chronic conditions and poverty encountered the problem of legitimacy toward the health care system. The problem of legitimacy could be defined as the perception of not having a legitimated place in the health care system. It comes with the humiliation that goes with poverty experience and with being perceived as ��bad patient�� through social experience of the health care system. Negative past experience of care, stigma, economics and social barriers of access to care and discouragement all play a central role in the occurrence of the problem of legitimacy. Relational accessibility through positive, inclusive and repetitive contacts with the primary health care system (both at the GP level and care organization level) is a core component of the effective social legitimacy. The capability of the primary health care system to take into account the roots of the social inequities and the problem of legitimacy experienced by patients is in my sense one avenue of solution for enhancing equity!

Competing interests

No competing interests.

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