Migrant Health Policies in the European Union: A Comparative Policy Analysis

Abstract

Research ObjectiveIn an era of increasing globalization and immigration, what extent is the state responsible for the health of resident noncitizens and how should it respond, if at all? This question relates to migrant health and health policy and has been particularly salient among European nations as they have responded to an increased flow of migrants in the last two decades. The objective of this research was to explore what are the similarities and differences in policy content that can be found among the eleven migrant health policies adopted in Europe and to what extent can they be grouped or classified?Study DesignA cross‐case study of eleven migrant health policies adopted by European nations, comparative analysis of policies that broadly share the same objective, provided insight into how a group of nations conceptualized, defined, operationalized, and responded to the health of migrant populations through a policy instrument. This study identified policy variation through a two‐phased analytic process that included content analysis followed by typological analysis.Population StudiedMigrant health policies adopted in Austria, England, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden, and Switzerland.Principal FindingsThe coding scheme from content analysis of the policies was mapped onto the typology framework, leading to the emergence of four themes that are conceptually distinct “types” of policy orientation toward migrant health that include assimilation, integration, health system adaptation, and health equity.Each theme has a unique relationship with the typology matrix’s two dimensions, access to care and quality of care that was determined by stronger or weaker levels of association. The assimilation theme has a weak association with access and quality, while health equity has a strong association with the two dimensions coming together at higher levels. The integration theme is related to access to care, while the health system adaptation theme is associated with quality of care.While the four themes are conceptually distinct, the policies seem to populate them as a continuum from assimilation to health equity, rather than being evenly distributed across all four themes. The assimilation and health equity themes have clear “anchor” policies that represent all aspects of them. The remaining policies link the end points continuum with varying levels of access and quality that increase from weak to strong, moving through the integration and health system adaptation themes toward health equity.ConclusionsProducts of this research include a comprehensive, transparent coding scheme of the data, a theme‐based migrant health policy typology, four themes that are conceptually distinct “types” of orientation toward migrant health, and a migrant health policy case continuum depicting policy case association with a theme. The typology goes beyond description and classification of policies by offering a higher level of understanding of variation across the themes and cases. This is a new framework from which to compare concepts, explore dimensionality, and identify hierarchical relationships.Implications for Policy or PracticeThis research contributes to the field of migrant health policy comparative analysis with tools to inform future policy making processes and guide future migrant health policy making processes, comparative policy analysis and migrant health outcomes research.Primary Funding SourceTokyo Foundation for Policy and Research.