What health care for undocumented migrants in Belgium?

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Migrant’s access to preventive health services in five EU countries

Background: Preventive health services (PHSs) form part of primary healthcare with the aim of screening to prevent disease. Migrants show significant differences in lifestyle, health beliefs and risk factors compared with the native populations. This can have a significant impact on migrants’ access to health systems and participation in prevention programmes. Even in countries with widely accessible healthcare systems, migrants’ access to PHSs may be difficult. The aim of the study was to compare access to preventive health services between migrants and native populations in five European Union (EU) countries. Methods: Information from Health Interview Surveys of Belgium, Italy, Malta, Portugal and Spain were used to analyse access to mammography, Pap smear tests, colorectal cancer screening and flu vaccination among migrants. The comparative risk of not accessing PHSs was calculated using a mixed-effects multilevel model, adjusting for potential confounding factors (sex, education and the presence of disability). Migrant status was defined according to citizenship, with a distinction made between EU and non-EU countries. Results: Migrants, in particular those from non-EU countries, were found to have poorer access to PHSs. The overall risk of not reporting a screening test or a flu vaccination ranged from a minimum of 1.8 times (colorectal cancer screening), to a high of 4.4 times (flu vaccination) for migrants. The comparison among the five EU countries included in the study showed similarities, with particularly limited access recorded in Italy and in Belgium for non-EU migrants. Conclusions: The findings of this study are in accordance with evidence from the scientific literature. Poor organization of health services, in Italy, and lack of targeted health policies in Belgium may explain these findings. PHSs should be responsive to patient diversity, probably more so than other health services. There is a need for diversity-oriented, migrant-sensitive prevention. Policies oriented to removing impediments to migrants’ access to preventive interventions are crucial, to encourage more positive action for those facing the risk of intersectional discrimination.Authors are thankful to FCT for funds to GHTM – UID/Multi/04413/2013

Health care for irregular migrants: pragmatism across Europe. A qualitative study

<p>Abstract</p> <p>Background</p> <p>Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countries.</p> <p>Results</p> <p>Semi-structured interviews were conducted with health professionals in 144 primary care services, 48 mental health services, and 48 Accident & Emergency departments (total n = 240). Although legal health care entitlement for IM varies across countries, health professionals reported facing similar issues when caring for IM. These issues include access problems, limited communication, and associated legal complications. Differences in the experiences with IM across the three types of services were also explored. Respondents from Accident & Emergency departments reported less of a difference between the care for IM patients and patients in a regular situation than did respondents from primary care and mental health services. Primary care services and mental health services were more concerned with language barriers than Accident & Emergency departments. Notifying the authorities was an uncommon practice, even in countries where health professionals are required to do this.</p> <p>Conclusions</p> <p>The needs of IM patients and the values of the staff appear to be as important as the national legal framework, with staff in different European countries adopting a similar pragmatic approach to delivering health care to IM. While legislation might help to improve health care for IM, more appropriate organisation and local flexibility are equally important, especially for improving access and care pathways.</p

Quelle coordination des soins de santé et du social pour assurer la continuité des prises en charge pour les publics précarisés en région de Bruxelles-Capitale ? Rapport final

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Les Compétences Culturelles sont-elles contagieuses ? Une analyse exploratoire des réseaux sociaux des professionnels de santé

Les Compétences Culturelles sont-elles contagieuses ? Une analyse exploratoire des réseaux sociaux des professionnels de sant

Asylum seekers in Belgium : options for a more equitable access to health care. A stakeholder consultation

135 p.ill.,1 INTRODUCTION .12 -- 2 SCOPE AND RESEARCH QUESTIONS 14 -- 3 METHODS 16 -- 4 CONTEXT OF INTERNATIONAL PROTECTION AND HEALTH CARE FOR ASYLUM SEEKERS IN BELGIUM .19 -- 4.1 INTERNATIONAL PROTECTION FOR ASYLUM SEEKERS .19 -- 4.1.1 Procedure for international protection: legal and administrative aspects 20 -- 4.1.2 Number of asylum seekers in Belgium .21 -- 4.1.3 Material assistance during the procedure for international protection 22 -- 4.2 HEALTH PROBLEMS, HEALTH CARE UTILISATION AND COSTS AMONG ASYLUM SEEKERS.26 -- 4.2.1 Health problems 26 -- 4.2.2 Health care utilisation and costs 26 -- 4.3 CURRENT ORGANISATION AND ACCESS TO HEALTH CARE FOR ASYLUM SEEKERS 27 -- 4.3.1 Legal framework 27 -- 4.3.2 Summary of the key organisational elements 33 -- 5 DESCRIPTION OF THE PROBLEMS .37 -- 5.1 PROBLEMS AT THE MACRO-LEVEL .37 -- 5.1.1 Lack of coordination 37 -- 5.1.2 Regional differences regarding health care for asylum seekers 37 -- 5.1.3 Lack of monitoring of health care use and health care costs 37 -- 5.1.4 Lack of transparency about health care expenses .38 -- 5.1.5 Lack of administrative support and of qualified personnel to manage administrative tasks 38 -- 5.2 PROBLEMS AT THE MESO-LEVEL .39 -- 5.2.1 Unclear administrative system for health care professionals 39 -- 5.2.2 Differences in health care system depending on place of stay 39 -- 5.2.3 Lack of health care professionals qualified to interact in health care for asylum seekers 40 -- 5.2.4 High turnover of health care professionals in reception centres 40 -- 5.2.5 Reluctance and/or overburdening of (some) health care professionals 40 -- 5.2.6 Poor and/or unclear collaboration between the different actors involved in health care for asylum seekers .41 -- 5.2.7 Tension regarding patient confidentiality .41 -- 5.2.8 Lack of appropriate health information for asylum seekers 41 -- 5.3 PROBLEMS AT THE MICRO-LEVEL 41 -- 5.3.1 Inequity in access .41 -- 5.3.2 Inequity in treatment 43 -- 5.3.3 Inequity in outcomes 44 -- 5.4 SPECIFIC PROBLEMS FOR HEALTH CARE WITH UNACCOMPANIED MINORS 45 -- 5.4.1 Lack of coverage through insurance funds for unaccompanied minors 45 -- 5.4.2 Difficulties to comply with the conditions to access the compulsory health insurance .45 -- 5.4.3 Shortage of guardians 45 -- 5.4 OTHER ISSUES 45 -- 6 OPTIONS TO IMPROVE EQUITABLE ACCESS TO HEALTH CARE FOR ASYLUM SEEKERS: RESULTS OF THE STAKEHOLDER CONSULTATION 48 -- 6.1 FUNDAMENTAL TRANSVERSAL PRINCIPLES TO IMPROVE EQUITABLE ACCESS .48 -- 6.2 DISTRIBUTION OF FUNDING OF HEALTH CARE FOR ASYLUM SEEKERS .49 -- 6.2.1 Option 1: Sickness funds acts as distributor of funding – integration of asylum seekers in compulsory Belgian health care insurance .49 -- 6.2.2 Option 2: Fedasil acts as distributor of funding .59 -- 6.2.3 Option 3: actual actors distribute the funding, administration by MedPrima for all asylum seekers and access to health care covered by health insurance 63 -- 6.3 FUTURE GOVERNANCE OF HEALTH CARE FOR ASYLUM SEEKERS 65 -- 6.4 IMPROVEMENTS TO THE CURRENT SYSTEM (QUICK WINS) 70 -- 6.4.1 Quick wins across organisations 70 -- 6.4.2 Quick wins on the level of the CPAS – OCMW 71 -- 6.4.3 Quick wins on the level of Fedasil 72 -- 7 CONCLUSION .72 -- 7.1 PREREQUISITES 72 -- 7.2 ESTIMATED EFFECT OF OPTIONS ON THE DESCRIBED PROBLEMS 73 -- 7.3 LIMITATIONS 7