title: The moral career of poor patients in free clinics.
abstract: This paper explores the lived experiences and the identity processes attached to attendance at free clinics. It draws on a qualitative study of 94 patients and 37 professionals who were interviewed at four free clinics in France. Since these facilities are for the poor and for people without health coverage, attendance reflects a medical experience as well as an experience of assistance, both of which have an impact on healthcare utilisation. Nevertheless, the meaning attached to the recourse to free clinics and the patients' lived experiences change over time and depend on interactions with clinic staff. This study proposes a typology of care recourse modes (occasional, regular and inconsistent attendance) crossed with different types of lived experiences. Occasional attendance and distant patient-professionals relationships, often due to the humiliation that some people feel when they have to ask for social assistance, characterise the first time people have recourse to care. Patients commit to regular follow-ups only when they have come to terms with their position in the medical and assistance system, doing so by rationalising and adjusting their identity. Our aim in discussing our findings is to gain greater insight into the utilisation of healthcare by different population groups and in different contexts.
authors.affiliation: Research Team on the Social Determinants of Health and Healthcare, Inserm U707, 27 rue de Chaligny, 75012 Paris, France. parizot@u707.jussieu.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Parizot
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvin
authors.forename: Serge
authors.initials: S
authors.lastname: Paugam
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics*; D005260:Female; D005602:France; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017057:Medically Uninsured; D009014:Morals; D005791:Patient Care; D010817:Physician-Patient Relations; D011203:Poverty