Health Care For Undocumented Migrants Research Articles

Caring for Undocumented Migrants: Significance of Recognition and Respect during Healthcare Encounters

Undocumented migrants are often in a position of extreme vulnerability and experience many barriers to accessing mental health care. It is crucial that health professionals understand this and quickly establish trust and respect. If the stressful living conditions that contribute to the distress of undocumented migrants are recognized, compassionate and trauma-informed care is enhanced. In this regard, it is important that health professionals understand the fear of being expelled from a country. This paper discusses problems that arise when health professionals interact with undocumented migrants and the need to quickly convey recognition to establish trust and respect. We argue that insights from Axel Honneth’s social philosophical theory of recognition and disrespect can further enhance health professionals strategies to improve their verbal and non-verbal communication and thereby increase access to health care for undocumented migrants. We suggest ideas for codifying this knowledge in health care policies and guidelines.

Health care for undocumented migrants

Health care for undocumented migrants

Barriers to accessing health care among undocumented migrants in Sweden - a principal component analysis

BackgroundUndocumented migrants face many hardships in their everyday life such as poor living conditions, discrimination, and lack of access to healthcare. Previous studies have demonstrated considerable health care needs for psychiatric disorders as well as physical diseases. The aim of this paper was to find out the main barriers that undocumented migrants experience in accessing the Swedish healthcare system and to explore their relation with socioeconomic factors.MethodsA cross-sectional study with adult undocumented migrants was performed in the three largest cities of Sweden in 2014–2016. Sampling was done via informal networks. A socioeconomic questionnaire was constructed including 22 barriers to health care. Trained field workers conducted the interviews. A principal component analysis was conducted of all barriers to reveal central components. Then, Pearson’s chi-squared test was used to explore the characteristics of undocumented migrants experiencing barriers to care.ResultsTwo main components/barriers were extracted: “Fear of being taken by police/authorities”, which was related to fear of disclosure by or in relation to seeking health care, and “Structural and psychosocial factors” which was related to practical obstacles or shame of being ill. Lower age (74.1 % vs 56.0 %), lower level of education (75.0 % vs. 45.1 %), and having no children (70.3 % vs. 48.1 %) were significantly related to a higher likelihood of experiencing a barrier.ConclusionFear of deportation and practical and psychosocial factors constitute hinderance of access to healthcare for undocumented migrants in Sweden. This highlights the importance of clear instructions, both to undocumented migrants and health professionals about the right to health care according to the international law on human rights as well as the law of confidentiality.

Access to oral health care for undocumented migrants: Perspectives of actors involved in a voluntary dental network in the Netherlands.

Undocumented migrants in Europe face multiple barriers in access to oral health care. This study aimed to explore the accessibility of a voluntary dental network providing dental treatments to undocumented migrants in the Netherlands, from the perspectives of patients, dentists and staff members of nongovernmental organizations involved. This qualitative study used semi-structured interviews (n=21) with undocumented migrants (n=12), dentists (n=7) and staff members of nongovernmental organizations (n=2) during the implementation of a voluntary dental network. Interviews were analysed using a framework analysis method. As a temporary answer to problems in access to oral health for undocumented migrants, the voluntary dental network targeted initial barriers to dental care. Main challenges within the network were conflicting expectations and perceived treatment outcomes by patients, dentist and NGO staff members, limited financial resources, logistic and communication barriers and an increasing administrative burden.Furthermore, feelings of compassion for and trust of the patient affected the ethics of the professional relationship and influenced treatment decisions of dentists. Through the implementation of a voluntary dental network, treatments could be provided to undocumented migrants as a temporary solution. However, the voluntary nature of dental care in the network resulted in a fragmented provision of oral health care among undocumented migrants. To reduce inequalities in oral health on the long term, systemic barriers in access to oral health care need to be addressed.

External Migrants under Mainland China's Informal Welfare Regime: Risk Shifts, Resource Environments, and the Urban Employees' Social Insurance

Social insurance in mainland China long catered to populations that were assumed to remain in one place permanently. In recent decades, however, internal and transnational labour migration has been on the rise. Building on existing research about internal migrants' social security, this study asks how different groups of external labour migrants cope with the social risk shifts induced by mobility. It focuses on documented migrants from UN member countries; from Taiwan, Hong Kong, and Macao; and on undocumented migrants. It employs the resource environment approach, which integrates a transnational perspective and acknowledges informal sources of security. Focusing on healthcare, the study argues that informal practices affect the majority of external migrants irrespective of nationality or migration status, protecting expatriates from double coverage, causing low-income migrants to fall through the gaps, but also enabling access to healthcare for undocumented migrants. Despite mandatory participation, effective migrant coverage of the Urban Employees' Social Insurance (UESI) remains low. The system is highly decentralized with incomplete internal and external portability, and cities have considerable leeway over their own migration and welfare regimes. Migrants from more socio-economically developed areas tend to have a greater reliance on public services and security from the sending areas, or on high-end private alternatives. Conversely, as the example of Nigerian traders illustrates, undocumented migrants piece together their protective arrangements from individual networks and community institutions. Religious organizations from the Global South also reach out transnationally and provide informal protections to migrant communities. This study employs a mix of ethnographic fieldwork, document analysis, and descriptive statistics.

Reduce obstacles, promote health-healthcare access for undocumented migrants within apilot project in Lower Saxony, Germany (2016-2018)

In 2014, the parliament of the federal state of Lower Saxony (Germany) implemented athree-year pilot project to reduce barriers to healthcare for undocumented migrants. For this purpose, two counselling centres (CCs) were established (Hanover and Goettingen), where undocumented migrants receive treatment vouchers for the medical treatment of acute medical issues, check-ups, and vaccination. We assessed which medical services were used in order to identify needs and recommend specific improvements to policymakers. We analysed CC data from the first two years after starting the project (1 February 2016-31 January 2018). We described demographic characteristics of attendees, reasons for attendance, and medical diagnoses. Additionally, we carried out explorative interviews on the subject of vaccination in one CC (February-May 2018). In total, 236 undocumented migrants received 698 vouchers. The number of vouchers issued increased over time: from 17/month (February-July 2016) to 44/month (August 2017-January 2018); 56% were female and 16% were younger than 18years. Half of the women (66/132) attended for prenatal care. In 4% (9/236) of attendees vaccinations were given. Of 25people approached for explorative interviews, 18participated. All of them were generally open about vaccinations; 12 (67%) had already received vaccinations at some point. The increasing use of CCs shows the need for low-threshold healthcare access, particularly for vulnerable groups (children, pregnant women). Vaccinations were rarely performed. Strengthening vaccination literacy by providing more information to both physicians and attendees can increase vaccination uptake.

7.5-O1Access to health care for undocumented migrants in Belgium: why are we still waiting for progress?

7.5-O1Access to health care for undocumented migrants in Belgium: why are we still waiting for progress?

1.3-O5The role of universality in guaranteeing access to healthcare for undocumented migrants: a comparative analysis of the Italian and British national health systems

1.3-O5The role of universality in guaranteeing access to healthcare for undocumented migrants: a comparative analysis of the Italian and British national health systems

The experience of nurses working within a voluntary network: a qualitative study of health care for undocumented migrants

To illuminate the experience of nurses providing health care to undocumented migrants in a voluntary network. In a qualitative study, semistructured interviews were conducted with RNs regarding their experience of providing health care to undocumented migrants within a voluntary network. The interview transcripts were analysed using the inductive method of content analysis. Three main categories emerged - structural inadequacy, ethical dilemmas and challenges, and personal impact and insights. The informants were driven by a strong ethical approach and a great sense of responsibility as human beings and as nurses. Engaging with the voluntary network allowed the informants to cope with their frustration and feelings of inadequacy which emerged when confronted with institutionalised injustice in the conventional healthcare system.

Reporting mental health problems of undocumented migrants in Greece: A qualitative exploration

Background: Mental health problems are highly prevalent amongst undocumented migrants (UMs), and often part of their consultations with general practitioners (GPs). Little empirical data are available of how GPs and UMs engage around mental health in Greece, a country with a lack of balance between primary and secondary care and limited healthcare provisions for UMs.Objectives: To acquire insight in the barriers and levers in the provision of mental healthcare for UMs by GPs in Greece.Methods: This was a qualitative study using semi-structured interviews with 12 GPs in Crete, Greece with clinical expertise in the care of UMs. All interviews were audio-taped and transcribed verbatim and were analysed using thematic content analysis.Results: Greek GPs recognized many mental health problems in UMs and identified the barriers that prevented them from discussing these problems and delivering appropriate care: growing societal resistance towards UMs, budget cuts in healthcare, administrative obstacles and lack of support from the healthcare system. To overcome these barriers, Greek GPs provided UMs with free access to care and psychotropic drugs free of charge, and referred to other primary care professionals rather than to mental healthcare institutions.Conclusion: Greek GPs experienced substantial barriers in the provision of mental healthcare to UMs and political, economic and organizational factors played a major role.

Access to Preventive Health Care for Undocumented Migrants: A Comparative Study of Germany, The Netherlands and Spain from a Human Rights Perspective

The present study analyzes the preventive health care provisions for nationals and undocumented migrants in Germany, the Netherlands and Spain in light of four indicators derived from the United Nations Committee on Economic, Social and Cultural Rights’ General Comment 14 (GC 14). These indicators are (i) immunization; (ii) education and information; (iii) regular screening programs; and (iv) the promotion of the underlying determinants of health. It aims to answer the question of what preventive health care services for undocumented migrants are provided for in Germany, the Netherlands and Spain and how this should be evaluated from a human rights perspective. The study reveals that the access to preventive health care for undocumented migrants is largely insufficient in all three countries but most extensive in the Netherlands and least extensive in Germany. The paper concludes that a human rights-based approach to health law and policy can help to refine and concretize the individual rights and state obligations for the preventive health care of undocumented migrants. While the human rights framework is still insufficiently clear in some respects, the research concedes the added value of a rights-based approach as an evaluation tool, advocacy framework and moral principle to keep in mind when adopting or evaluating state policies in the health sector.

The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context.

The recent introduction of adjustment measures in the Spanish context by means of the Royal Decree-law 16/2012 (RDL 16/2012), which limits access to health care for undocumented migrants, raises the question about the state of the matter in different European Union member states. Narrative review of comparative studies published between 2009 and 2012 that analyzes the right to health care for undocumented migrants in the European context. The review shows a high degree of variability regarding health care entitlements of undocumented migrants in different European countries, a frequent legal restriction of access to health care, as well as barriers in the effective access to health care. The studies coincide in recommending access at all health care levels, regardless of the administrative status of the person seeking treatment. The analysis of the impact of the current economic crisis on access and quality of the health care directed to undocumented migrants, as well as the knowledge of the migrants' perspective are identified as future research areas. Compared with other European countries, the introduction of the measures established in the RDL 16/2012 modifies the place of the Spanish Public Health Care System from being situated in the group of countries that permit undocumented migrants access to all health care levels, towards the category of highest restriction.

Denunciation: a new threat to access to health care for undocumented migrants.

In February last year I went to a European meeting on the care of destitute migrants.1 There are estimated to be 2.6 to 6.4 million across the European Union (0.5% to 1% of the population of the EU)2 and half a million such undocumented migrants in the UK.3 The hospitality industry in the south east of England depends heavily on them, so that one person's illegal immigrant is another person's helpful waiter.4 The situation of these migrants in the UK has recently been described in good qualitative research.5 As the conference was running, thousands of migrants were landing on the Italian island of Lampedusa to avoid the Libyan crisis. I will first review what is already established about access to health care for undocumented migrants, then describe a new threat highlighted at this conference; denunciation. The current situation regarding the health care of legal migrants in the EU has been well described by two officials from the International Organisation for Migration (IOM): > ‘European countries face a threefold situation of: (i) constant migrant flows, (ii) health services and practices that are largely inaccessible or unused by migrant populations and often ill-suited to migrants' needs and (iii) higher vulnerability of migrants and their children to ill health due to negative socioeconomic circumstances. On the other hand, protection of migrants' health and their access to quality health care are recognised as: (i) a human right and a basic entitlement according to EU values; (ii) vital to migrants' integration and critical to reduce poverty and (iii) essential for social cohesion, good public health and the wellbeing of all.’6 Where the migrant is legal the EU is committed to improving access …

Access to Health Care for Undocumented Migrants: A Comparative Policy Analysis of England and the Netherlands

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.

Providing medical care for undocumented migrants in Denmark: what are the challenges for health professionals?

BackgroundThe rights of undocumented migrants are frequently overlooked. Denmark has ratified several international conventions recognizing the right to health care for all human beings, but has very scanty legislation and no existing policies for providing health care to undocumented migrants. This study focuses on how health professionals navigate and how they experience providing treatment for undocumented migrants in the Danish health care system.MethodsThe study was carried out as part of an EU-project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). This presentation is based on 12 semi-structured interviews with general practitioners (9) and emergency room physicians (3) in Denmark.ResultsThe emergency room physicians express that treatment of undocumented migrants is no different from the treatment of any other person. However, care may become more complicated due to lack of previous medical records and contact persons. Contrary to this, general practitioners explain that undocumented migrants will encounter formal barriers when trying to obtain treatment. Additional problems in the treatment of undocumented migrants include language issues, financial aspects for general practitioners, concerns about how to handle the situation including possibilities of further referrals, and an uncertainty as to whether to involve the police.ConclusionsThe health professionals in our study describe that undocumented migrants experience an unequal access to primary care facilities and that great uncertainties exist amongst health professionals as how to respond in such situations. The lack of official policies concerning the right to health care for undocumented migrants continue to pass on the responsibility to health professionals and, thereby, leaves it up to the individual to decide whether treatment can be obtained or not.

Right of access to health care for undocumented migrants in EU: a comparative study of national policies

The aim of this article is to characterize policies regarding the right of access to health care for undocumented migrants in the 27 Member States of the European Union and to identify the extent to which these entitlements are congruent with human rights standards. The study is based on a questionnaire sent to experts, non-governmental organizations and authorities in the Member States between April and December 2009, as well as on available reports and official websites. Primary sources were also consulted as regards legislation. Right of access to health care differs considerably between Member States. States can be grouped into 3 clusters: in 5 countries undocumented migrants have the right to access care that is more extensive than emergency care; in 12 countries they can only access emergency care and in 10 countries not even emergency care can be accessed. These variations are independent of the system of financing or the numbers of undocumented migrants present. Rather, they seem to relate to the intersection between practices of control of migration, the main types of undocumented migrants present and the basic norms of the welfare state-the 'moral economy' of the work society. International obligations articulated in human rights standards are not fully met in the majority of Member States. A more complete understanding of the differing policies might be obtained by considering the relationship between the formal and informal economy, as well as the role of human rights standards within the current 'moral economy'.