رهیافت انتقادی به کالایی‌شدن سلامت و طردشدگی سالمندان تهیدست

در جامعه ایران سلامت و درمان، کالایی گران‌بها و ارزشمند است که در بازار عرضه و خرید و فروش می‌شود. در چنین حالتی می‌توان از «کالایی‌شدن سلامت» صحبت کرد. مسئله پژوهش حاضر این است که کالایی‌شدن سلامت برای سالمندان به‌عنوان مشتریان همیشگی نظام سلامت و درمان، چه پیامدهایی دارد. در پژوهش کیفی حاضر، به‌کمک مصاحبه‌های عمیق و نیمه‌ساختاریافته با 28 نفر از سالمندان تهرانی (افراد بالای 65 سال) به این سوال پاسخ داده شد. برای شناسایی سالمندان ترکیبی از نمونه‌گیری‌های هدفمند، مانند نمونه‌گیری ناهمگون و نمونه‌گیری نظری استفاده شد. نمونه‌گیری ناهمگون برای شناسایی سالمندان در سنخ‌های متنوع و نمونه‌گیری نظری برای دستیابی به اشباع مفهومی کاربرد دارد. درنهایت داده‌های مصاحبه‌ای به روش تحلیل مضمون، کدگذاری و مقوله‌بندی شدند. نتایج پژوهش نشان می‌دهد «سلامت طبقاتی‌شده، فقیرشدگی نظام سلامت دولتی و جاماندگی سالمندان تهیدست» از پیامدهای کالایی‌شدن سلامت برای سالمندان طبقات اجتماعی پایین‌دست است که درنهایت به طردشدگی و جاماندگی سالمندان تهیدست می‌انجامد. از پیامدهای دیگر کالایی‌شدن سلامت برای جامعه سالمندان می‌توان به احساس محرومیت طبقاتی، فقیرسازی سالمندان تهیدست، صف‌های طولانی انتظار، حذف سلامت از سبد مصرفی، ناتوانی مالی تهیدستان و روی‌آوری به خوددرمانی اشاره کرد.

Critical Approach to Commodification of health and exclusion of the poor elderly

Introduction: In the society of Iran, health is a valuable commodity which is sold in the market. In this situation, we can speak about “commodification of health”. The result of commodification will be treating it as something for obtaining benefits. In such a condition, Monetization, market values and inequality will increase. It seems that the Iranian society gradually have had some paradigm changes in heath discourse and the government’s economic withdrawal in general supplying of health services and expansion of the private sector in the health system. In this discourse the patient is considered as a costumer who must provide the expenses of his health and treatment. Furthermore, health is considered as a personal commodity rather than a public one which all people have the right of access to it. In such a system, instead of patient’s need, patient’s purchasing power is the criterion for access to health services. Therefore, the current study is that what are the consequences of health commodification for the elderly as the regular consumers of health system? Method: This study has been done through “Qualitative Research” and “indepth and SemiStructured Interviews” with 28 elderly people in Tehran (people over 65 years old). To identify the elderly has been used a combination of purposeful samplings such as “Maximum Variation Sampling” and “Theoretical sampling”. The Maximum Variation sampling is used for finding the elderly in various types and theoretical sampling is used to achieve conceptual saturation. Finally, the interview data were coded and categorized by “Thematic analysis”. Besidesthe qualitative research, the health related documents have been investigated.   Results and discussion: The results indicated that classified health, poor governmental health system and ignored the poor elderly are amongst the consequences of Commodification of health for the elderly in low social classes and at last will be resulted in exclusion and ignorance of the poor elderly. Other consequences of Commodification of health can be pointed to the feeling of class exclusion, increasing poverty among the poor people, removing health from consumption basket, financial inability of the poor and turn to selfcuring. The greatest victims of the health system are the poor and ill elderly who because of their age are the fixed customers of the health and treatment system. As the poor elderly live in an insecure and inflammatory economic society, will be resulted in providing some essentials for their life and sometimes they will remove health services from their consumption basket. Commodification of health will be resulted in classified health and it will be continued to the classified differences in having access to health services. As a result of all this differences and inequalities the experience of ageing in the Iranian society will turn into a multiple experience and the rich elderly have a good access to the commodified health system. As a result, the economic capital is considered as an important factor in the ageing experience.       Conclusion: In commodification of health condition, the poor elderly share is nothing but exclusion. Nowadays the Iranian government needs to be more responsible for the poor elderly. The Iranian government must decommodification of health services and consider it as an essential commodity. Furthermore, paying attention to Prevention and general care besides cure in social health policy for the elderly is important.