Are Healthcare Systems Failing Immigrants? Transnational Migration and Social Exclusion in the Workers’ Compensation Process in Québec

Background: The changing world of work, which increasingly depends on the use of temporary and atypical forms of employment, has had a disproportionate effect on the health and well-being of immigrants. When they have to find a health professional for the first time or report an accident at work, the journey through the maze of medical-administrative bureaucracy can be long and arduous. The aim of this article is to describe the analytical contribution of systems thinking by presenting three situations that illustrate the importance of connecting the individual, organizational, and societal levels, especially focusing on the interplay between these levels. Methods: The data analyzed in this article are taken from an initial qualitative exploratory study of a purposive sample of 40 individuals: (1) clinicians (N = 15), (2) claims consultants and rehabilitation counselors (N = 14), (3) employers (N = 2), and (4) immigrant workers (N = 9). Situations were analyzed using insights from grounded theory by identifying the interconnectedness of individual, organizational, and system-based factors that can have an impact on the return-to-work process. Results: By looking specifically at the context of occupational rehabilitation in contemporary Québec and the challenges faced by immigrant workers faced with multiple factors of precariousness, this article sets out to show how local healthcare systems are poorly equipped to respond to the new reality of transnational migration. Conclusion: Drawing from recent research in the area of systemic theory, this article posits that systems, which are poorly adapted to the new reality of transnational migration, have the unintended consequence of creating new forms of discrimination and social exclusion.