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Author: Jacqueline Britz, Virginia Commonwealth
University School of Medicine, Class of 2017
Background: Vulnerable populations in the
United Kingdom (UK), similar to other countries throughout the
world, face many obstacles to accessing healthcare. The English
Department of Health is currently consulting on a proposal that may
end free access to primary healthcare for some migrants, in
response to concerns over budget constraints and the perceived
costs and extent of "health tourism" in the United Kingdom (UK).
This RESEARCH project, conducted in collaboration with Doctors of
the World UK, explored the existing model of healthcare in the UK
and potential implications of the proposed restrictions to
healthcare. The final report presents recommendations for
policymakers and key stakeholders to promote more equitable access
to healthcare. The themes and recommendations that emerged from
this RESEARCH project have relevance beyond the UK, and could
provide valuable insights into opportunities and challenges for
promoting health equity in the Unites States.
Methods: A literature review of undocumented
migrants' access to healthcare in England was performed and a broad
variety of stakeholders, including Members of Parliament, senior
professionals from the Department of Health and Public Heath
England, clinicians, and staff from charities with extensive
experience with migrants, were interviewed. A coding strategy was
developed integrating elements of thematic coding and framework
analysis. Collection, analysis, and interpretation of data were
guided by the Dahlgren and Whitehead Social Model of Health and the
Commission on Social Determinants of Health Conceptual
Findings, Recommendations, and Conclusions:
There are a number of factors that compromise the health of
vulnerable migrants in England, including dire financial
circumstances, unstable housing another living conditions, and
barriers to accessing healthcare (e.g. confusion over entitlements
and administrative barriers, fear, discrimination, and charging).
The Government's proposal to restrict access to healthcare in
England based on immigration status would threaten the health of
vulnerable individuals and public health, given the importance of
primary care in the prevention and early detection of infectious
diseases. This proposal would also increase pressure (and
consequently costs) on already over-burdened accident and emergency
(A&E) departments as well as conflict with the Government's
legal and ethical obligations. This report therefore recommends
that the Government should not implement restrictions on access to
NHS primary care based on immigration status. Interviews with
experts identified several key principles of successful models of
healthcare that should be integrated within the NHS structure to
promote health equity, including the following: accountability and
transparency, aligning incentives, collaboration and integration,
effective collection and sharing of data, and changing cultural
norms. This report calls for a coordinated and multisectoral
strategy to addressing health inequalities in the UK, and outlines
specific recommendations from which other developed countries may
January 2015 Issue of IMpact