‘The good patient gets it all’: access to healthcare for persons with multiple chronic conditions

Background: Access to health care for all is a recognized policy ideal. This formally equal access does, however, not necessarily reflect itself in equal use and benefit of services. On the contrary, access varies across social, cultural, financial and organisational settings and is often limited for persons with multimorbidity (users). Multimorbidity involves care across health sectors and specialties, making managing treatment programs challenging for both users and health care professionals (HCPs). This study explores how users and HCPs experience access to health care and how socio-cultural settings influence the interaction between users and HCPs.
Methods: Data included interviews with users (n=14), workshop with users and relatives (n=1) and workshops with HCPs in municipality, hospital and general practice (n=5). Data were analyzed with systematic text condensation.
Findings: Encounters between healthcare users and HCPs influenced the perceived outcomes of healthcare. Users experienced that being a ‘good patient’ and ‘asking the right questions’ enabled better health care in terms of receiving knowledge and influencing treatment options. Thus, users felt responsible for outcomes of user-provider interactions which was particularly difficult in decisions related to prioritising between the management of different chronic illnesses. HCPs experienced that users’ socio-cultural resources impacted not only interactions but treatment options. Whereas ‘resourceful’ users could manage long-term goals for their illness progression, ‘less resourceful’ users could only manage short-term and urgent matters. Moreover, HCPs often relied on ‘resourceful’ users’ ability to pass on central knowledge between sectors and specialities.
Conclusion: Recent years’ focus on self-management in multimorbidity may have affected the way responsibility is divided in user-provider encounters. ‘Good patients’ possessing these cultural skills of alignment with those of professionals are likely to receive better quality of care. Thus, users with socio-cultural resources are more equipped to partake in beneficial user-provider interactions promoting the benefits of being a ‘good patient’, leaving those without the skills with limited access to healthcare.