Every year, millions of people migrate to escape global economic and often life-or-death problems. Problems like starvation, war, trafficking, violence, and corruption. And yet, upon arrival, these migrants and refugees are sure to face yet another expensive and unexpected issue – healthcare.
Healthcare for refugees and immigrants is a complex problem for both migrants and healthcare providers. A painful lesson by the COVID pandemic, these issues often need to be tackled clumsily on short notice and budget:
- Health insurance
- Legal status
- Clinic & hospital capacity
- Language barrier
- Personal safety
- Education & training
- Emergency situations
- Billing & paperwork
Migration is a global phenomenon, with nearly 272 million international immigrants and 740 million on the move. Migration is socially detrimental to health.
The Migrant Healthcare System
What is the migrant healthcare system?
The migrant healthcare system is a network of hospitals, clinics, and other health care providers that provides care to migrants who are living in or traveling through a foreign country. This network relies on donations from governments, organizations, and individuals to stay operational.
Who benefits from the migrant healthcare system?
Migrants benefit from the migrant healthcare system in a number of ways:
- Access to quality medical services at affordable prices
- Receive treatment for conditions that they wouldn’t be able to access in their home country
How affordable is healthcare for migrants?
There are a number of ways in which migrants can access quality medical services at affordable prices.
- Many migrant health clinics offer low-cost or free services to those who need them
- There are also government-run health clinics that offer free or low-cost care to all residents, regardless of immigration status
- Some healthcare providers offer reduced rates to people in the process of migration
- Some insurance companies offer discounts for those who have valid proof of residency in a foreign country
What are the unique challenges of immigrants and refugees?
Newcomers to foreign countries often find it difficult adjusting to a new culture, learning a new language, and overcoming barriers in accessing social services.
- Migrants who live in developing countries are susceptible to illnesses such as malaria and HIV/AIDS
- Migrant workers often experience work-related injuries that can require extensive medical care
- Susceptibility to illness while traveling, such as food poisoning or malaria
- Receive care for injuries or illnesses that they may have while traveling
How to support migrants as a healthcare provider
Be aware of the different needs of migrants
Migrants may require different types of care than the general population, such as access to mental health services or specialized medical treatments. Migrant workers are often in need of basic health care, such as vaccinations and mental health services, which are not always available or affordable in their home countries.
Offer discounted rates
Many migrant workers are in need of basic health care, such as vaccinations and mental health services, which are not always available or affordable in their home countries. Offering these services at a low cost can make them accessible to many migrants.
Consider cultural differences
Migrants may experience different cultural norms when it comes to health and illness.
The need for treatment is often more urgent
Migrants may not have access to the same medical treatments that are available in their home country. It is important to be sensitive to the fact that many migrants are traveling long distances and they may be in a hurry.
Migrant Healthcare Issues
Health issues facing migrants are similar to problems the general population faces but are often compounded and magnified by a migratory lifestyle. Mobility does not provide for continuity in care and increases its need.
Like other underserved populations, migrants struggle with access to healthcare. Barriers include limited eligibility for privately or publicly funded healthcare programs, lack of familiarity with local healthcare services, cultural differences, language, and mobility.
In the U.S. the uninsured rate for the underinsured has decreased since the Affordable Care Act, but many migrant workers, such as farmworkers, cannot afford deductibles and co-pays.
Healthcare does not follow migrants on the move. A migratory lifestyle places them out of provider networks, which reduces access. Undocumented workers are not eligible for ACA coverage. Fear of governmental agencies’ contact and deportation make healthcare more complicated.
Health Needs En-Route
Migrants moving to a new location encounter health risks, such as cold or heat stress, exposure to disease, and dehydration as they cross borders or travel within a country. They are more vulnerable, which may increase incidences of exploitation and trafficking.
Migrant and immigration populations work in risky industries, including construction, fishing, forestry, and agriculture. They have a higher rate of injuries and fatalities than workers in other sectors. Foreign-born workers are more apt to die at work than workers born in the United States.
Exposure to Toxins
Farmworkers in the field and their families are exposed to pesticides. Families come into direct contact with parents and family members who are farm workers. Migrant workers are also exposed to other chemicals, such as industrial manufacturing products and industrial and household cleaners. Chemical exposure poses health risks.
Regulatory and Legal Concerns
There is a history of legal agricultural exclusions that result in insufficient on-the-job protections for farmworkers. Workers may not know their rights or fear being labeled a ‘whistleblower’ when rights are violated. There is information available. (https://www.migrantclinician.org/workerscomp)
Sanitation and Housing
Healthcare workers need to be aware of migrant patients’ well-being and health risks. They include dilapidated structures, inadequate sanitation, unsafe and substandard electrical, cooking, heating systems, and unsafe drinking water.
Over half of farmworker households have food supply issues. They may lack cooking facilities, food storage, and access to transportation.
Change in Climate
The poor are disproportionally affected by the change in the climate. Migrant farmworkers who work outdoors are particularly vulnerable. More vector-borne diseases, degraded air quality, extreme weather, and increased temperatures are factors of climate change that affect the health of those who work outdoors.
Substandard housing puts migrants at a higher risk because they lack air conditioning and insulation. Outdoor workers are subject to a higher risk of heat-related illnesses because they have fewer resources to adapt to changes.
Healthcare Workers Serving Migrants
Throughout the U.S., health centers serve the migrant population in their communities. They receive funds from the Federal Migrant Health Program, which serves nearly 800.000 patients.
The Migrant Clinicians Network consists of radiologists, dieticians, pharmacists, administrators, promotes de Salud, outreach workers, nurse practitioners, physicians, and nurses dedicated to helping the mobile poor. They serve more than 10,000 constituents.
Impact of Mobility
Mobility impacts a person’s physical vulnerability and mental and social well-being. Mobile populations and migrants face obstacles in accessing essential healthcare services.
Inaccessibility to services, a lack of migrant-inclusive health policies, language barriers, and irregular immigration status play a role. The disparity impacts the well-being of the immigrant and the community acting as a host.
The goal of preventing, treating, and eliminating influenza, malaria, tuberculosis, and HIV is undermined. High mortality and morbidity, particularly in exploitative, forced, or irregular migration situations, are critical health concerns worthy of international attention.
In March 2020, the International Organization of Migration, the Government of Spain, and the World Health Organization organized a Global Consultation of the Health of Immigrants. The key priorities are
- Monitoring migrant health
- Migrant sensitive health systems
- Policy and legal framework
- Partnerships, networks, and multi-country frameworks
Through disseminating information and research, the knowledge of migrant health is strengthened and ensures evidence-based policy development and programming.
It promotes, facilitates, and delivers comprehensive and migrant-friendly healthcare services. The International Organization of Migration enhances government partners’ operational and technical capacity. It is committed to strengthening and developing multi-sectoral coordination and partnerships among migrants, stakeholders, and member states.
Millions of people try to escape from life-or-death or global economic problems by migrating to another country every year. They are trying to escape corruption, violence, trafficking, war, and starvation.
Healthcare is an unexpected and expensive problem the refugees and migrants face when they arrive in a new country. The issues are complex for healthcare providers and immigrants. Dealing with the COVID pandemic has taught some painful lessons.
The issue was clumsily managed by a system that was on a tight budget and received short notice. Issues included
- Billing and paperwork
- Clinic and hospital capacity
- Education and training
- Emergency situations
- Health insurance
- Language barrier
- Legal status
- Personal safety
Resources for Migrants
Both the health of immigrants and America suffer when people are forced to live in fear due to immigration status. Many immigrant families do not seek social and healthcare services out of fear of interacting with public agencies.
In general, fewer immigrants have health insurance or access to healthcare, and they receive a lower quality of care than those born in the U.S. To make matters worse, the fear of deportation has harmful effects on their mental and physical health.
Children are particularly vulnerable to trauma. It is a barrier to their mental and physical health and development. The Affordable Care Act of 2010 mandates most U.S. citizens and legal residents carry insurance.
Medicaid was expanded in 32 states as a result. Undocumented immigrants aren’t eligible for state-based exchanges or Medicaid. The number of uninsured in the U.S. has decreased, but it is citizens and legal residents who gained health insurance access for the most part.
The Emergency Medical Treatment and Labor Act passsed by Congress passed in 1986 requires hospitals to provide emergency and active labor care even if a person does not have insurance or is an undocumented immigrant.
Medicaid also has an emergency care provision, which is the only federal insurance available to undocumented immigrants. Emergency Medicaid can also be used to stabilize a patient but may not cover services after a patient is stabilized.
The Supplemental Food Program for Women, Infants, and Children and Child Health Block grants are Federal provisions available to undocumented immigrants. They include care for children and prenatal care.
CHIP (Children Health Insurance Programs) was expanded in 2015 with Federal funds that made available a Medicaid benefit package for Early and Periodic Screening, Diagnostic, and Treatment Services for medically necessary
- Hospital services and care
- Access to medical specialists
- Prescription drugs and vaccinations
- Denta and mental health services
These resources are for a vulnerable subset of undocumented immigrants. There are not many resources for sick adults who are not pregnant. There are community Federal Qualified Health Centers that get Federal grant money to support the care of the uninsured regardless of immigration status.
Nearly 1200 health centers operate around the country that provide pharmacy services, mental health, dental, and healthcare based on a sliding scale of ability to pay. There are also free and low-cost community clinics that rely on volunteers and private donations to provide services for those unable to pay.
Public Health in England
One in seven people in the United Kingdom comes from another country. They came from all around the globe for various reasons. Some are in poor health and unfamiliar with the available healthcare services.
Asylum seekers and refugees are more vulnerable and have complex health needs. There is a many factors that influence the vulnerability and resilience of migrants. They include
- Individual lifestyles
- Social and community influences
- Living and working conditions
- General socioeconomic, cultural, and environmental conditions
Each has an impact on migrant health. As migrants move from their countries to a new location, these factors vary over time. Healthcare services may be very different from the country from which they came.
Some migrants may struggle with the way the NHS works. They do not know who to trust or where to go when they have a health issue. The belief that they have to pay or cannot pay for healthcare services keeps people away from seeking help.
Cost to Migrants
In some instances, migrants are charged for service if they are not U.K. residents. An individual’s immigration status and the type of healthcare needed influence whether a migrant will be charged for services.
Nurse and G.P. consultations in primary care are free to all who register with a General Practitioner as an NHS patient or access services as a temporary patient. Temporary patients are in the area for more than a day and less than three months.
Secondary care services are resident-based. The individual must live lawfully in the U.K. to be eligible for free healthcare. Some services are free regardless of resident status if the individual did not travel to the U.K. to receive the treatment. They include:
- Accident and emergency services
- Diagnosis and treatment of sexually transmitted infections
- Family planning (Does not include abortion or fertility treatment)
- Treatment for a mental or physical condition due to sexual violence, domestic violence, female genital mutilation, or torture
- Hospice services provided by a community interest company or registered palliative care charity
- NHS 111 telephone advice services
Treating migrant cases effectively often involves ad-hoc changes to institutional and procedural norms and habits. For example, a language barrier may require an interpreter and updates to websites, documents, and other materials. If a foreign person shows up with an emergency and doesn’t speak the language of the clinic, what should be done? These types of situations should be addressed in a formal change management program.
Implementing a change management program can prevent failures, legal issues, and stress. The goal is for everyone to be aware of the culture, responsibilities, and resources available to them. A good program should outline issues such as:
- Translation and language support
- Training frequency and depth
- Legal responsibilities
- Partner clinics and contact info
- Managing migrant treatment guide
- Stress management for staff
- Xenophobia management
- Smooth complaint process
- Reducing bureaucracy
Migrant Treatment Guide
Clinics should develop their own migrant treatment guide to outline the procedures, contacts, rules and responsibilities of staff, patients and their families. This shouldn’t be an extremely lengthy document that no one will read. It should be available as a webpage or set of webpages that can be consumed on any device. Use of images, links, and good formatting will increase the usefulness and acceptance within the organization.
Immigrant and refugee healthcare
Access to Primary Care
Access to Secondary Care
Which countries offer free healtchare for migrants?
- Country name
The Center for Disease Control and Prevention developed a communication toolkit that helps healthcare providers and systems, community organizations, health departments, and public health professionals reach refugee populations who may need information about COVID-19 prevention in their language.
The toolkit includes:
- Current information from a trusted source
- Plain language that can be downloaded and shared
- Material that is translated to help disseminate the data to a broader audience.
After educational sessions with refugees and focus groups, four documents about seasonal flu were developed. The materials are meant to improve information about seasonal flu in the refugee population.
All the documents use visual clues and minimal text to portray the information so that low literacy populations find them helpful. There are also resources available in several languages about
- Hepatitis B
- Severe weather and natural disasters
International Migrant Health Resources
United States Resources
U.S. Migrant Health Program
The National Center for Farmworkers is a non-profit corporation dedicated to improving farmworker families’ health status. The organization provides technical assistance and training, information services, and various products to migrant and community health centers across the nation and to individuals, researchers, universities, and organizations involved in farmworker health.
- United Nations (UN) Migrant Health Division
- World Heath Organization (WHO) Refugee and Migrant Health Resources
- UK Government Migrant health guide
- US National Center for Farmworker Health Migrant Health Center Locations
- CDC Immigrant, Refugee, and Migrant Resources
- Resources for women in NY: https://hermigranthub.org/
Migrant Resources in Canada
In Canada, the migrant healthcare system is funded by the government and operated by various organizations, including Health Canada, the Canadian Red Cross, and private health care providers. Migrants benefit from the migrant healthcare system in a number of ways:
- Migrants can access quality medical services at affordable prices.
- Migrants can receive treatment for conditions that they may not be able to treat in their home countries.
- Migrants can receive care while they are living in the UK without having to worry about paying for it themselves.
Migrant health centers
- Migrant health center list
Global Insurance Options
What’s the difference between a migrant and an immigrant?
Immigrants leave their homes permanently whereas migrants generally intend to leave temporarily. A migrant may become an immigrant if the desire and opportunity arise.
What’s the difference between a migrant and a refugee?
Migrants generally choose to leave their homes whereas refugees are usually forced, e.g. because of a war. However, these words are often used interchangeably and it’s hard to know what the person using them means without asking.