Towards universal coverage for international migrants in Chile: accessibility and acceptability indicators from a multi-methods study
Main Article Content
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.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. WHO. Universal health coverage (UHC). http://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc). Published 2017.
2. Allin S. Does Equity in Healthcare Use Vary across Canadian Provinces? Healthc Policy. 2008;3(4):83-99.
3. Patient Access Parternship. 5A′s of Access. http://www.eupatientaccess.eu/page.php?i_id=19.
4. Homer CSE, Castro Lopes S, Nove A, et al. Barriers to and strategies for addressing the availability, accessibility, acceptability and quality of the sexual, reproductive, maternal, newborn and adolescent health workforce: addressing the post-2015 agenda. BMC Pregnancy Childbirth. 2018;18(1):55. doi:10.1186/s12884-018-1686-4
5. Goudge J, Gilson L, Russell S, Gumede T, Mills A. Affordability, availability and acceptability barriers to health care for the chronically ill: Longitudinal case studies from South Africa. BMC Health Serv Res. 2009;9(1):75. doi:10.1186/1472-6963-9-75
6. Schoeffler LM. Denying lawful immigrants access to state healthcare subsidies violates the equal protection provision of the Massachusetts Constitution--Finch v. Commonwealth Health Insurance Connector Authority. Am J Law Med. 2012;38(1):228-232.
7. Yang JS. Contextualizing Immigrant Access to Health Resources. J Immigr Minor Heal. 2010;12(3):340-353. doi:10.1007/s10903-008-9173-z
8. Cabieses B, Gálvez P, Ajraz N. Migración internacional y salud: el aporte de las teorías sociales migratorias a las decisiones en salud pública. Rev Peru Med Exp Salud Publica. 2018;35(2):285. doi:10.17843/rpmesp.2018.352.3102
9. Dias SF, Severo M, Barros H. Determinants of health care utilization by immigrants in Portugal. BMC Health Serv Res. 2008;8(1):207. doi:10.1186/1472-6963-8-207
10. Heyman JM, Núñez GG, Talavera V. Healthcare Access and Barriers for Unauthorized Immigrants in El Paso County, Texas. Fam Community Health. 2009;32(1):4-21. doi:10.1097/01.FCH.0000342813.42025.a3
11. Gideon J. Exploring migrants’ health seeking strategies: The case of Latin American migrants in London. Int J Migr Heal Soc Care. 2011. doi:10.1108/17479891111206328
12. INE. Resultados CENSO 2017. 2018.
13. Cabieses B, Tunstall H, Pickett KE, Gideon J. Understanding differences in access and use of healthcare between international immigrants to Chile and the Chilean-born: a repeated cross-sectional population-based study in Chile. Int J Equity Health. 2012;11(1):68. doi:10.1186/1475-9276-11-68
14. Cabieses B, Pickett K, Tunstall H. Comparing Sociodemographic Factors Associated with Disability Between Immigrants and the Chilean-Born: Are There Different Stories to Tell? Int J Environ Res Public Health. 2012;9(12):4403-4432. doi:10.3390/ijerph9124403
15. Cabieses B, Tunstall H, Pickett K. Testing the Latino paradox in Latin America: A population-based study of Intra-regional immigrants in Chile. Rev Med Chil. 2013;141(10):1255-1265. doi:10.4067/S0034-98872013001000004
16. Cabieses B, Pickett KE, Tunstall H. What are the living conditions and health status of those who don’t report their migration status? a population-based study in Chile. BMC Public Health. 2012;12(1):1013. doi:10.1186/1471-2458-12-1013
17. Bernales M, Cabieses B, McIntyre AM, Chepo M, Flaño J, Obach A. Determinantes sociales de la salud de niños migrantes internacionales en Chile: evidencia cualitativa. Salud Publica Mex. 2018;60(5, sep-oct):566. doi:10.21149/9033
18. Cabieses B, Chepo M, Oyarte M, et al. Brechas de desigualdad en salud en niños migrantes versus locales en Chile. Rev Chil pediatría. 2017;88(6):707-716. doi:10.4067/S0370-41062017000600707
19. Markkula N, Cabieses B, Lehti V, Uphoff E, Astorga S, Stutzin F. Use of health services among international migrant children – a systematic review. Global Health. 2018;14(1):52. doi:10.1186/s12992-018-0370-9
20. Infante A, Mata I de la, Lopez-Acuna D. Reforma de los sistemas de salud en America Latina y el Caribe: situacion y tendencias. Rev Panam Salud Publica. 2000. doi:10.1590/S1020-49892000000700005
21. Arteaga Ó, Thollaug S, Nogueira AC, Darras C. Información para la equidad en salud en Chile. Rev Panam Salud Pública. 2002. doi:10.1590/S1020-49892002000500012
22. Albala C, Vio F. Epidemiological transition in Latin America: the case of Chile. Public Health. 1995;109(6):431-442.
23. DINRED (División de Inversiones y Desarrollo de la Red Asistencial). Sistematización de Estudios de Red Asistencial de Salud: Visión Nacional.; 1999.
24. Cabieses B, Tunstall H. Socioeconomic vulnerability and its association with access to healthcare among immigrants in Chile. In: Thomas F, Gideon J, eds. Migration, Health and Inequality. London: Zen; 2012.
25. McKendrick JH. Multi-Method Research: An Introduction to Its Application in PopulationGeography. Prof Geogr. 1999;51(1):40-50. doi:10.1111/0033-0124.00143
26. Ministerio de Desarrollo Social. Metodología de Diseño Muestral Encuesta de Caracterización Socioeconómica Nacional 2013. Santiago, Chile; 2015.
27. Ministerio de Desarrollo Social. Metodología de Diseño Muestral Encuesta de Caracterización Socioeconómica Nacional, Casen 2015. Santiago, Chile; 2016.
28. Ministerio de Desarrollo Social. CASEN 2017: Metodología de Diseño Muestral. Santiago, Chile; 2018.
29. INE (Instituto Nacional de Estadísticas). CHILE: Proyecciones y Estimaciones de Población. 1950-2050. Total País. 2008:1-89.
30. Hargreaves S, Friedland JS, Gothard P, et al. Impact on and use of health services by international migrants: questionnaire survey of inner city London A&E attenders. BMC Health Serv Res. 2006;6(1):153. doi:10.1186/1472-6963-6-153
31. Schenk L, Neuhauser H. Methodological standards for migrant-sensitive epidemiological research. Bundesgesundheitsblatt GesundheitsforschGesundheitsschutz. 2005;48(3):279-286. doi:10.1007/s00103-004-0995-0
32. Reijneveld SA. Reported health, lifestyles, and use of health care of first generation immigrants in The Netherlands: do socioeconomic factors explain their adverse position? J Epidemiol Community Health. 1998;52(5):298-304.
33. Llacer A, Zunzunegui M V., del Amo J, Mazarrasa L, Bolumar F. The contribution of a gender perspective to the understanding of migrants’ health. J Epidemiol Community Heal. 2007;61(Supplement 2):ii4-ii10. doi:10.1136/jech.2007.061770
34. Razum O, Zeeb H, Rohrmann S. The ’healthy migrant effect’--not merely a fallacy of inaccurate denominator figures. Int J Epidemiol. 2000;29(1):191-192.
35. Razum O. Income inequality and mortality in Canada and the United States. Low mortality in Canadian cities may be driven by low mortality in immigrants. BMJ. 2000;321(7275):1533-1534.
36. Politzer RM, Yoon J, Shi L, Hughes RG, Regan J, Gaston MH. Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care. Med Care Res Rev. 2001;58(2):234-248. doi:10.1177/107755870105800205
37. Shi L, Politzer RM, Regan J, Lewis-Idema D, Falik M. The Impact of Managed Care on the Mix of Vulnerable Populations Served by Community Health Centers. J Ambul Care Manage. 2001;24(1):51-66. doi:10.1097/00004479-200101000-00007
38. Gushulak BD, MacPherson DW. Health Aspects of the Pre-Departure Phase of Migration. PLoS Med. 2011;8(5):e1001035. doi:10.1371/journal.pmed.1001035
39. Scheppers E. Potential barriers to the use of health services among ethnic minorities: a review. Fam Pract. 2006;23(3):325-348. doi:10.1093/fampra/cmi113
40. Eshiett MUA, Parry EHO. Migrants and health: a cultural dilemma. Clin Med. 3(3):229-231.
41. Servicio Impuestos Internos. Valores y fechas: Dolar observado.