Barriers to access to healthcare service in rural Ontario: Qualitative study through the lens of the right to development
本研究基于发展权框架，通过25次半结构化访谈，识别了加拿大安大略省牛津县农村医疗服务的结构性、系统性和个体性障碍，并提出了集体发展权政策，强调医疗作为集体权利需要结构性保障、制度化参与和尊严支持。
The Right to Development provides the central framework for this study, guiding an examination of barriers to healthcare access in Oxford County, a rural region of Ontario, Canada. The Right to Development emphasises that health is a collective entitlement shaped by structural conditions and shared social responsibilities. Using this perspective, the study argues that individual rights to healthcare are insufficient for understanding or addressing rural inequities. Drawing on twenty-five semi-structured interviews conducted between January and April 2025 and analysed through Braun and Clarke's reflexive thematic approach, three themes were identified. Structural barriers include infrastructure gaps, physician shortages, limitations in walk-in clinics, and prolonged wait times. Second, systemic inefficiencies arise from centralised service organisation and administrative shortcomings that leave some residents temporarily uninsured. Third, the individual appraisal highlights the importance of provider diversity, participation and inclusion, and community engagement for meaningful access. The primary contribution of this study is the development of the Collective Right to Development policy, which applies and extends the Right to Development to rural health systems. The Collective Right to Development policy identifies three collective entitlements required for equitable healthcare: structural provision and service diversity; institutionalised participation and community governance; and conditions that support dignity and well-being. These entitlements translate the Right to Development principles into concrete obligations and reveal rural health inequities as collective deprivations embedded in structural design. The absence of Right to Development–based collective principles in Canadian health policy undermines accountability, neglects rural system strengthening, and perpetuates inequitable access for underserved populations. • Identifies structural and systemic barriers to healthcare in rural Ontario. • Equity Gap: Healthcare framed only as an individual entitlement fails; the Right to Development (RTD) offers a stronger framework by embedding health in collective right to development (CRD) responsibility. • Collective Right Development (CRD) highlights healthcare as a communal good, requiring for equitable service diversity; institutionalised participation and community governance; and conditions that support dignity and well-being. • The study challenges libertarian views of healthcare as a service, affirming instead its role as a fundamental good tied to dignity, equality, and survival.