Quebec Studies

I Will Always Remember You: A Narrative Approach Towards Understanding the Inpatient Experiences of HIV Patients in Montreal

Quebec Studies (2012), 54, (2), 71–90.

Abstract

71 71 I Will Always Remember You: A Narrative Approach Towards Understanding the Inpatient Experiences of HIV Patients in Montreal Denver Lewellen Dalhousie University Since the early 1990s health care restructuring has played a prominent role in the delivery of health services services in Canada (Maioni (Maioni 2007). For patients, these changes often result in shorter hospital stays and increased utilization of outpatient care (Côté et al. 1998; of 1998; Rowe 2008). An understanding of how shifting health care practices practices are experienced experienced can have implications implications for maintaining satisfactory satisfactory levels of health services services during an era of constant change. Correlations have long been established linking patient satisfac­ satisfaction and the seeking of medical advice, continuing relationships with health providers, and complying with prescribed treatments (Lochman (Lochman 1983, 1983, CarrHill 1992, 1992, Smith 1994, Urden 2002, 2002, Guteling et al. 2008). In Québec, In Québec, health care restructuring is a major political political issue, and since the 1990s both patients and providers have witnessed the province's health care shift to a system often characterized characterized by shorter inpatient times in hospitals that are understaffed. Currently, health care spending in Qué­ Québec is higher than any other government spending, yet this increased bec spending has fallen short of keeping up with the demand for services. To the chagrin of those who detest any concessions concessions to a U.S.-style U.S.-style system of out-of-pocket payment, the provincial government proposed per-person contributions (starting at $25 and graduating to $100 by 2012) for individual health services services (Simpson (Simpson 2010). This proposal was rejected rejected out of concern that patient contributions may be in violation of the Canada Health Act. Without this revenue, however, the Québec health care system faces faces a $500 million dollar shortfall (Peritz 2010). Throughout this era of health care restructuring, the city of Montreal has remained a center for cutting edge HIV research and treatment. This article details the results of a qualitative health services services survey conducted with HIV patients in Montreal between 1997 1997 and 1998. 1998. The time frame of the study allows for a retrospective look at the experiences experiences of patients — many of whom remembered receiving health care prior the significant significant cut­ cutbacks in the 1990s — relative to the contested health care terrain in the province today, as well as allowing prospective views on the impact of fu­ future health care restructuring for other, diverse patient populations. Additionally, as HIV is currently undergoing a shift in classification classification to that of a "manageable chronic illness," there is risk that awareness of the unique of socio-cultural dynamics that characterized characterized the historic health care experi­ experiences of HIV patients will go by the wayside (Gahagan et al. 2012). Subse­ Subsequently, results from this study will underscore the distinct experiences experiences of of Special Issue, Fall 2012 2012

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Lewellen, Denver