Why access to health services is hard work: negotiating access in a cross-sectoral mental health program in Denmark

Even in universal healthcare systems structured around principles of free and equal access, inequity in health continues to increase. This study explores how access to healthcare services is constructed in the intersection between individual experiences, organisational arrangements, and broader structural conditions. Using the analytical concept of candidacy, we examine how health and social care professionals and people seeking and receiving care negotiate access in everyday practice. Empirically, the study is based on a critical case study of a novel intersectoral care model for people with severe mental illness implemented in three Danish municipalities. The study draws on an ethnographically inspired design, including 34 individual interviews with people receiving care and health and social care professionals, three focus group interviews with health and social care professionals, and 15 observations of home visits and staff meetings. We show that, even after formal inclusion in a program designed to support access, people receiving care still had to work hard to engage with health and social care professionals, communicate symptoms and care needs, and sustain their eligibility for care. We argue that the candidacy framework helps explain access as an ongoing negotiated process across individual, organisational, and structural levels.