English - World Health Organization Regional Office for Europe

Migrants’ access to health services 73
In most EU countries, undocumented migrants do not have any recognized
legal status, which in many cases results in minimal access to health care
(Björngren-Cuadra and Cattacin 2010).
The second step towards improving migrants’ access to health care
concerns health policies. Migrants’ health and access to health care should be
incorporated explicitly into health policy documents at local, regional, national
and EU levels, including guidelines on how to overcome financial, geographical,
language and cultural barriers in relation to migrants’ access to health care. A
recent comparative study demonstrated that some European countries are more
progressive on this than others (Lorant and Bhopal 2010) (see also Chapter 12
on “Migrant health policies in Europe”).
Third, the way in which health systems are organized also has major
implications for migrants’ possibilities of accessing care. Health systems need
to consider whether established ways of delivering services meet the needs of
changing demographics. Healy and McKee (2004) have outlined several delivery
models in response to population diversity. These models can be divided into
two overall approaches: mainstream services for all or separate services for
migrants. Separate services imply a higher political profile, empowerment
of migrants and more targeted services, but they may lead to anti-migrant
sentiments. In contrast, proponents of mainstream provision for all argue that
this is non-discriminatory, strengthens social solidarity, and that alternative
services can undermine unified national health systems. According to McKee
(2002), the question of mainstream or specific services depends on the context
and, in particular, the political power of the migrant group and their resulting
ability to take charge of the services they receive. To date, most European health
systems have not developed specific services for migrants, preferring rather to
mainstream provision into existing health care structures (see also Chapter 12
on “Migrant health policies in Europe”). Another issue is that services need to
be geographically accessible and sufficient in numbers. Increasing “knowledgerelated
access” is also important, including through the systematic provision
of information on health services to all newcomers. “Linguistic access” can
be promoted by ensuring an adequate number of professional interpreters,
bilingual staff or cultural mediators, with health education material and
awareness campaigns developed for specific ethnic and linguistic groups, taking
into account levels of education and literacy.
Finally, it is important to improve the clinical encounter between health
personnel and migrant patients. A growing body of literature shows that
misunderstandings and unsatisfactory communication are prevalent in
encounters with migrant patients, hampering health service provision and
outcomes. Access to professional interpretation should be ensured formally,
financially and in daily practice for all patients without sufficient language skills
in order to enable them to communicate adequately with health professionals.
Otherwise, both patients and health workers are confronted with lack of
information, the risks of inappropriate diagnostic procedures, and negative
effects on adherence and quality of care. Introducing cultural mediators into
health care is seen by many as an additional innovation in order to enhance
cross-cultural communication and understanding. More informal support