Abstract
ABSTRACT Background Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access. Objective This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). Methods The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals. Results No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing. Conclusions For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women’s possibility to access healthcare services and being undocumented led to restricted access entitlement and to fear rejection at health centres. Therefore, besides ensuring immigrants’ legal entitlement, there is need of promoting rights-based attention to get more inclusive health systems.
Highlights
Immigrant populations experience diverse barriers to access healthcare services in the host countries
In order to get a more complete perspective of the barriers that hinder the access to healthcare services for immigrant women and undocumented immigrants in our setting, exploratory specific objec tives were stablished: 2) To determine the perception of healthcare professionals working in free clinics on the barriers and facilitators of access to healthcare services by immigrant women and undocumented immigrants in the Basque Country and 3) To analyse Sub-Saharan African immigrant women’s perceptions and experiences of access to appropriate healthcare services in the Basque Country
The main results of the thesis for achieving the spe cified objectives were the following: From January 2007 to June 2017, a total of 9,272 health consultations were attended in the primary healthcare free clinic, 76.94% for men and 23.06% for women. 49.58% of the women and 40.03% of the men attended the clinic for the first time (Table 3)
Summary
Immigrant populations experience diverse barriers to access healthcare services in the host countries. Objective: This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). The thesis considered available quantitative data of free clinics and the experiences and perceptions of immigrants and healthcare professionals working at the free clinics to explore the access to appropriate healthcare services for immigrants in the Basque Country. It was mainly focused on the access of undo cumented immigrants and immigrant women from low-income countries, since they are the ones in most vulnerable situations. In the Basque Country, which is one of the autonomous regions of
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