Health Policy - Migrant Issues in Health Policy - MRN: Migrant Rights Network

Publication: towards progressive immigration policy

(42 page .pdf)

Migration Opportunity
Map Project (MOMP)

Publication: Migrant Voices, Migrants Rights

Health Policy:

Migrant Issues in Health Policy

There are many ways in which policy of health and health care provision interacts with the rights and interests of migrants. To provide a map of these complex interactions we have summarised them in into five man areas:

Entitlements to healthcare
Equality of access to health services
Migrant workers in the health care sector
Border controls and health checks for migrants
Medical evidence in asylum cases

Entitlements to healthcare:

Summary: regulations increasingly restrict the access of certain types of migrants to primary and secondary healthcare. Since 2004 the categories of migrants classed as ‘chargeable overseas visitors’ who must pay for their own treatment have been extended. Those who have not been lawfully resident for at least 12 months are required to pay for some forms of treatment. However, immediately necessary treatment is not to be delayed while chargeable status is determined and some services, diseases and patient groups are exempt. For a table of entitlement to NHS treatment see: http://www.dh.gov.uk/assetRoot/04/13/33/33/04133333.pdf

This impetus to remove access to healthcare from certain migrants including irregular migrants and asylum seekers whose claims have failed encounters several difficulties. First, the complexities involved in identifying who is entitled to access particular aspects of the health service makes the regulations difficult to implement. Second, there is a potential risk to wider public health in denying access to sections of the population particularly in the case of infectious diseases. Third, restrictions in access to secondary care may not be cost effective if the result is a higher usage of emergency services. Fourth, no evidence has been produced to show that the health care sector is in need of protection from ‘health tourism’.

Equality of access to health services:

Summary: There is a strong link between low socio-economic status and poor health outcomes. Migrants often belong to low income groups and suffer additional disadvantage as migrants. These factors result in lower health outcomes. Also some migrant groups may have particularly high levels of health needs due to traumatic migration experiences or increased levels of isolation.

The challenges of ensuring equal access to health care services include difficulties in providing services that are accessible and appropriate. Factors affecting the accessibility and appropriateness range from the location of service providers to the availability of interpreting services and the existence of outreach work that connects hard-to-reach groups (some of which are migrants) to health care services.

Increasing diversity among the migrant population provides additional challenges for health care providers in providing services tailored to the needs of their communities which may be changing rapidly. Furthermore the high degree of transience among particular migrant communities frequently interrupts continuity of care and raises barriers to accessing services.

Migrant workers in the healthcare sector

Summary: As well as using health services migrants play a major role in the provision of health services. However, migrants are often employed below their skill levels in the health sector due to difficulties in making qualifications transferable. Similar problems affect migrants with unrecognised medical qualifications who find employment outside the health care sector

The recruitment of large numbers of migrant workers in the health care sector has also lead to debates about the ethics of attracting such workers away from, predominantly, developing countries. The argument is whether the migration of qualified health care personnel has a positive or negative effect on development.

Finally, as the largest employer in the UK the NHS could be well placed to act as a skills escalator for lower skilled migrants. Employment and training of migrants in non-professional grades in the NHS could act as a means of equipping them with the skills and knowledge to be better integrated into the labour market.

Border controls and health checks for migrants

Summary: The potentially adverse effects of migration on public health are periodically raised. Some policy proposals have raised the possibility of introducing health screening of migrants in relation to infectious diseases such as tuberculosis. The manageability and effectiveness of such programmes is questionable. Various classes of potentially infected persons would not be subject to immigration control and incubation periods for various diseases make such systems cumbersome. There are further questions whether coercive screening programmes provide better public health protection or operate to increase risks by driving infected people underground.

Medical evidence in asylum cases

Summary: Complex questions arise in the use of medical evidence in asylum cases. First there are issues of sufficient opportunity for medical experts to prepare such evidence. This becomes more acute where the processing of cases is increasingly fast. Second there are issues around how medical evidence is evaluated in the asylum decision-making process. There are difficulties related to the escalating cost of producing expert medical evidence for more and more cases. However, these must be balanced against inadequacy and inappropriateness of non-specialist interviewing techniques within the asylum process.

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