Abstract
ABSTRACT
Background: Universal health coverage (UHC) is a major global public health goal. UHC means that all individuals and communities receive the health services they need without suffering financial hardship. Equitable UHC considers several minimum dimensions of access to healthcare, such as accessibility and acceptability. We aim to update data on accessibility and acceptability to healthcare for international migrants in Chile and to compare it to the Chilean-born population.
Methods: Multi-methods study. For accessibility, we measured healthcare provision entitlement by international immigrants and compared them to the Chilean-born population, based on data from the anonymous national representative CASEN survey at different time points; 2013, 2015 and 2017. For acceptability, we collected and analysed qualitative data focussed on exploring the perceptions of the Chilean healthcare system according to immigrants and based on individual interviews that were conducted in Chile between 2015 and 2017.
Results: In relation to accessibility, a growing proportion of immigrants has no healthcare provision, rising from 8,9% in 2013 to 18,6% in 2017. These rates are 3,5% higher than rates for Chileans without healthcare provision in 2013, and 4,4% higher amongst immigrants compared to Chileans in 2017. Regarding acceptability, immigrants report four main dimensions affecting their perception of care: administrative barriers to effective access to healthcare, interpersonal and cultural barriers to effective access to healthcare, perceived quality of care, and adequacy of healthcare delivery based on individual and cultural differences.
Discussion: We found persistent unequal accessibility and acceptability to healthcare services in Chile in detriment of the international migrant population compared to the Chilean-born population. We found a significant gap in the percentage of people with no healthcare provision entitlement between migrants and Chileans, which grew over time. These findings raise concerns of inequitable access to healthcare in Chile based on migration status.