Self-care and social class: Unpacking inequities in healthcare access during a healthcare reform

Abstract

This article explores the implications of social class for healthcare access and self-care practices among patients with complex multimorbidity in Denmark. Despite universal health coverage, socioeconomic disparities persist in healthcare access. We analyze qualitative data stemming from a summative evaluation of a complex intervention to improve integrated care for these patients, which included extended consultations in general practice. Using a sociocultural and psychosocial concept of class, we examine how patients engage with normative ideals of patient behavior and self-care. By highlighting two extreme cases, our findings reveal significant class-based differences in patients’ health practices. While the middle-class patient actively engages in his treatment, the lower-class patient struggles with more pressing life issues, relegating chronic illness management to the background. We argue that future healthcare reforms emphasizing differentiated treatment based on increased self-care may inadvertently exacerbate existing inequity. Such insights are crucial for developing equitable healthcare policies that address the complex interplay between social class and access to healthcare.