Purpose

This paper aims to provide a comprehensive understanding of factors that contribute to refugees’ exclusion from health-care services. More specifically, using institutional theory, this paper identifies regulative pillar-, normative pillar- and cultural/cognitive pillar-related challenges that result in refugees having limited or no access to health-care services.

Design/methodology/approach

The paper draws on both secondary research and empirical insights from two qualitative fieldwork studies totaling 37 semi-structured meso-level interviews, observations and focus groups in three Turkish cities (Izmir, Ankara and Edirne), as well as a total of 42 micro-level, semi-structured interviews with refugees and migrants in one large city (Izmir) in Turkey.

Findings

This study reveals that systematically stratified legal statuses result in different levels of access to public health-care services for migrants, asylum seekers or refugees based on their fragmented protection statuses. The findings suggest access to health-care is differentiated not only between local citizens and refugees but also among the refugees and migrants based on their legal status as shaped by their country of origin.

Originality/value

While the role of macro challenges such as laws and government regulations in shaping policies about refugees have been examined in other fields, the impact of such factors on refugee services and well-being has been largely ignored in service literature in general, as well as transformative service research literature in particular. This study is one of the first attempts by explicitly including macro-level factors to contribute to the discussion on the refugees’ access to public health-care services in a host country by relying on the institutional theory by providing a holistic understanding of cognitive, normative and regulative factors in understanding service exclusion problem.

中文翻译：

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土耳其难民的健康权和获得医疗保健服务的权利

目的

本文旨在全面了解导致难民被排除在医疗保健服务之外的因素。更具体地说，本文使用制度理论确定了与监管支柱、规范支柱和文化/认知支柱相关的挑战，这些挑战导致难民获得医疗保健服务的机会有限或无法获得。

设计/方法/方法

该论文借鉴了两项定性实地调查的二级研究和实证见解，共 37 个半结构化的中观层面访谈、观察和焦点小组在三个土耳其城市（伊兹密尔、安卡拉和埃迪尔内），以及总共 42 个微观层面的研究。在土耳其的一个大城市（伊兹密尔）对难民和移民进行水平、半结构化的访谈。

发现

这项研究表明，系统分层的法律地位导致移民、寻求庇护者或难民因其分散的保护地位而获得不同程度的公共医疗保健服务。研究结果表明，获得医疗保健的机会不仅在当地公民和难民之间有所不同，在难民和移民之间也有所不同，这取决于他们的原籍国所塑造的法律地位。

原创性/价值

虽然其他领域已经研究了法律和政府法规等宏观挑战在制定难民政策方面的作用，但这些因素对难民服务和福祉的影响在一般服务文献以及变革性文献中基本上被忽视了。尤其是服务研究文献。本研究是首次尝试明确纳入宏观层面的因素，通过提供对认知、规范和理解服务排斥问题的调节因素。