Is health a right for all? An umbrella review of the barriers to health care access faced by migrants

Abstract

Objective. To synthesise the scientific evidence concerning barriers to health care access faced by migrants. We sought to critically analyse this evidence with a view to guiding policies.

Design. A systematic review methodology was used to identify systematic and scoping reviews which quantitatively or qualitatively analysed data from primary studies. The main variables analysed were structural and contextual barriers (health system organisation) as well as individual (patients and providers). The quality of evidence from the systematic reviews was critically appraised. From 2674 reviews, 79 were retained for further scrutiny, and finally 9 met the inclusion criteria.

Results. The structural barriers identified were the lack of health insurance and the high cost of drugs (non-universal health system) and organisational aspects of health system (social insurance system and national health system). The individual barriers were linguistic and cultural. None of the reviews provided a quality appraisal of the studies.

Conclusions. Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones, and determinants of access to the respective health services should be analysed within the corresponding national context. Generate social and institutional changes that eliminate barriers to access to health services is essential to ensure health for all.

Keywords:

• migrants
• health services
• access
• barriers
• review

Acknowledgements

Thanks to Clare Bambra for inspiring this study and guiding us with her publications. Thanks to Vicente Clemente for offering technical support in this study.

Funding

This study is funded by the Health and Immigration Programme of CIBER Epidemiología y Salud Pública (CIBERESP), Spain.

Key messages

1. Despite the heterogeneous nature of migratory processes, migration aimed at seeking work and improving the social conditions of the migrant population, and their families has predominated.

2. To date, reviews focusing on migrant access to health services are scarce, extremely diverse, of poor quality and show considerable deficiencies concerning the factors which influence barriers to health care for migrants in host countries.

3. Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones.

4. Current scientific evidence concerning barriers to health care access by migrants could be useful to guide future policies.

Additional information

Funding

Funding: This study is funded by the Health and Immigration Programme of CIBER Epidemiología y Salud Pública (CIBERESP), Spain.