Experiences among undocumented migrants accessing primary care in the United kingdom: a qualitative study (original) (raw)
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Migrant access to NHS healthcare
InnovAiT: Education and inspiration for general practice, 2018
The three core principles of the NHS: that it meets the needs of everyone, that it be free at the point of delivery, that it be based on clinical need not ability to pay, are under threat. Recent policy changes compromise these principles by denying treatment to those in need who cannot pay. This article will give an overview of the policy changes and the impact these have on individuals in vulnerable situations trying to access care, on healthcare staff and our society. Case studies from the Doctors of the World clinic are used to illustrate the effect these changes are having. All names have been changed to protect anonymity.
Background: Recent British National Health Service (NHS) reforms, in response to austerity and alleged 'health tourism, ' could impose additional barriers to healthcare access for non-European Economic Area (EEA) migrants. This study explores policy reform challenges and implications, using excerpts from the perspectives of non-EEA migrants and health advocates in London. Methods: A qualitative study design was selected. Data were collected through document review and 22 in-depth interviews with non-EEA migrants and civil-society organisation representatives. Data were analysed thematically using the NHS principles. Results: The experiences of those 'vulnerable migrants' (ie, defined as adult non-EEA asylum-seekers, refugees, undocumented, low-skilled, and trafficked migrants susceptible to marginalised healthcare access) able to access health services were positive, with healthcare professionals generally demonstrating caring attitudes. However, general confusion existed about entitlements due to recent NHS changes, controversy over 'health tourism, ' and challenges registering for health services or accessing secondary facilities. Factors requiring greater clarity or improvement included accessibility, communication, and clarity on general practitioner (GP) responsibilities and migrant entitlements. Conclusion: Legislation to restrict access to healthcare based on immigration status could further compromise the health of vulnerable individuals in Britain. This study highlights current challenges in health services policy and practice and the role of non-governmental organizations (NGOs) in healthcare advocacy (eg, helping the voices of the most vulnerable reach policy-makers). Thus, it contributes to broadening national discussions and enabling more nuanced interpretation of ongoing global debates on immigration and health. Implications for policy makers • Interviews with vulnerable migrants and healthcare advocates indicated issues with confusing or unnecessary administrative demands, gatekeeper communications, and confidentiality/data protection fears within the national context of immigration fears and austerity-related entitlement changes. • Restricting healthcare access based on immigration status could further compromise the health of vulnerable individuals, with consequences for public health equity and social cohesion. Implications for the public This research gives voice to vulnerable migrants, many leaving situations of significant deprivation and danger, who describe their experiences with British National Health Services (NHS). National political discourse, in which non-European immigrants are less deserving or must be prevented from taking advantage, is divisive and one-sided. Findings help broaden the national discussion, enabling more nuanced interpretation of ongoing global debates on migration and health.
Journal of Health Politics, Policy and Law, 2012
The presence of undocumented migrants is increasing in many Western countries despite wide-ranging attempts by governments to increase border security. Measures taken to control the influx of immigrants include policies that restrict access to publicly funded health care for undocumented migrants. These restrictions to health care access are controversial, and evidence suggests they do not always have the intended effect. This study provides a comparative analysis of institutional, actor-related, and contextual factors that have influenced health care policy development on undocumented migrants in England and the Netherlands. For undocumented migrants, England restricts its access to care at the point of service, while the Netherlands restricts through the payment system for services. The study includes an analysis of policy papers and semistructured, in-depth interviews with various actors in both countries. Findings confirm the influence of such contextual factors as immigration considerations and cost concerns on health care policy making in this area. However, these factors cannot explain the differences between the two countries. Previously enacted policies, especially the organization of the health care system, affected the kind of restrictions for undocumented migrants. Concerns about the side effects of generous treatment of undocumented migrants on other groups played a substantial role in formulating restrictive policies in both countries. Evidently, policy development and implementation is critically affected by institutional rules, which govern the degree of influence that doctors and professional medical associations have on the policy process.
Social Science & Medicine - Mental Health, 2022
This article contributes new insights into how refugees, asylum seekers and undocumented migrants experience access to healthcare in the UK from both the perspective of caseworker volunteers and the assessment of policy regulations that influence such experiences. Drawing on material taken from qualitative interviews conducted with Doctors of the World caseworkers and Freedom of Information documents from NHS trusts, we reveal the various complexities faced by refugees, asylum seekers and undocumented migrants when trying to access vital health care. These issues include, charging regulations, the refusal to register patients at GP practices without proof of ID, language barriers and complications navigating the healthcare system. We found that such deterrents lead to risky help and health seeking, lack of or inadequate healthcare, and worse health outcomes among these populations. DOTW caseworkers perceived policies such as charging regulations, to be unjust as they plunge patients into significant debt, which is reported to the Home Office and can lead to the detainment or deportation of patients and their families. Study participants called on the UK government to recognise health as a fundamental human right, to develop inclusive social policy and to create an empathetic health system that allows refugees, asylum seekers and undocumented migrants equitable access to health and social services. To achieve health for all, they argued the need for clearer guidelines regarding access to healthcare and charging regulations, with some suggesting the importance of revising current Department of Health and Social Care policies and Home Office measures. Our article concludes that there is a need to tackle the underlying causes of ill health, including discriminatory policies, racism, and exclusion; addressing the social and economic determinants of health; and providing meaningful and culturally sensitive healthcare and social support.
British Journal of General Practice, 2019
BackgroundAsylum seekers and refugees (ASR) face difficulty accessing health care in host countries. In 2017, NHS charges for overseas visitors were extended to include some community care for refused asylum seekers. There is growing concern that this will increase access difficulties, but no recent research has documented the lived experiences of ASR accessing UK primary health care.AimTo examine ASR experiences accessing primary health care in the UK in 2018.Design and settingThis was a qualitative community-based study. ASR were recruited by criterion-based sampling through voluntary community organisations.MethodA total of 18 ASR completed face-to-face semi-structured recorded interviews discussing primary care access. Transcripts underwent thematic analysis by three researchers using Penchansky and Thomas’s modified theory of access.ResultsThe qualitative data show that participants found primary care services difficult to navigate and negotiate. Dominant themes included langua...
Health Policy, 2016
There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.
BMJ open, 2014
To explore health-seeking behaviour and experiences of undocumented migrants (UMs) in general practice in relation to mental health problems. Qualitative study using semistructured interviews and thematic analysis. 15 UMs in The Netherlands, varying in age, gender, country of origin and education; inclusion until theoretical saturation was reached. 4 cities in The Netherlands. UMs consider mental health problems to be directly related to their precarious living conditions. For support, they refer to friends and religion first, the general practitioner (GP) is their last resort. Barriers for seeking help include taboo on mental health problems, lack of knowledge of and trust in GPs competencies regarding mental health and general barriers in accessing healthcare as an UM (lack of knowledge of the right to access healthcare, fear of prosecution, financial constraints and practical difficulties). Once access has been gained, satisfaction with care is high. This is primarily due to the ...
There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalized situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalized migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.
Illness and healthcare experiences of recent low-income international migrants in a UK city
Multiple factors account for inequality in health outcomes and in access to healthcare in the UK, including ethnicity. This thesis explores length of residency in a country after migration through the subjective experiences of a group of recent low-income international migrants who have used local health services to seek care for a range of illnesses and conditions. The project was formulated in collaboration with Brighton and Hove City Council and the then NHS Brighton and Hove (now Brighton and Hove Clinical Commissioning Group) to recruit participants and collect narratives from this hard to reach social group. The theoretical background of this research draws on ‘lived’ experience in the context of illness. Analysis of qualitative interviews used narrative typologies derived from the work of Frank (1991), revealing both the commonalities across and the specificities of illness experiences, and highlighting a multi-factorial web of bio-psychosocial and economic factors at play. The interviews overwhelmingly fitted with a chronic, ‘chaos’ typology, in which diagnoses were commonly contested. The particularities of recent migrant status impacted upon participants’ illness experiences and healthcare use with migrants making comparisons with health systems in their countries of origin and managing healthcare through social networks. The findings from the data analysis around patient experience showed that the overall experience was negative, characterised by themes of problems in communication and access. Some outcomes were explained in terms of direct and indirect discrimination. Direct discrimination and stigma were perceived by many participants with attitudes and practices of staff, and the theme of ethnicity, immigration status and faith being stated. From this study it is possible to hypothesise that some healthcare practices and policy may give rise to the perceptions of discrimination.