This article brings the social science concept of ‘deservingness’ to bear on clinical cases of transnational migrant patients. Based on the authors’ medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.

International audienc

This article explores how staff in French public hospitals are indirectly involved in the governing of migration through healthcare. It unpacks the construction of differentiated values of life assigned to specific categories of vulnerable (authorised and unauthorised) migrants according to their perceived un/deservingness in context of budgetary restrictions. This context emphasises tensions between medical and administrative staff in the decision-making process regarding access to healthcare. The analysis rests upon empirical data (participant observations and semi-directed interviews) gathered in ‘healthcare access units’ located in public hospitals. Perceptions of un/deservingness lead to both healthcare rationing and healthcare denial and are built upon entangled criteria related to both migration status and budgetary concerns. These mechanisms reveal the administrative and budgetary dimensions that underlie the perceptions of health-related un/deservingness, which is linked to the costs of healthcare: the higher the costs, the less likely patients are to be designated to be deserving of healthcare.

À l’aide d’une sociologie des passeurs, cet article propose d’analyser le transfert, puis la consolidation des normes du « soin de la précarité » vers l’hôpital public français. Une première phase d’exportation des normes du champ associatif vers l’hôpital public (1990-1998) met en scène des « passeurs de conviction », occupant une position éminente à cheval entre le monde associatif et le monde hospitalier, et aboutit à l’institutionnalisation des normes sous la forme des permanences d’accès aux soins de santé (PASS). La seconde phase de consolidation, de défense et d’adaptation des normes (2000-2015), se déroule au sein de l’institution hospitalière et met en scène des professionnels des PASS. L’observation des passeurs et de leurs initiatives permet de mieux comprendre ce que la construction d’une politique de santé publique doit aux scansions du transfert puis de l’institutionnalisation, qui impliquent des acteurs aux profils sociologiques différents, soucieux de convaincre des publics tout aussi différents d’une phase à l’autre.

National audienceAccessing hospital care is a privilege for a growing proportion of the population in situations of economic and social precarity. It is therefore important that caregivers understand these difficulties in order to adapt their nursing approach.L’hôpital est la porte d’entrée privilégiée d’une partie grandissante de la population en situation de précarité économique et socialeC’est pourquoi il est important que les soignants comprennent ces difficultés afin d’optimiser leurs interventions