Access to healthcare and alternative health-seeking strategies among undocumented migrants in Denmark

Abstract

BackgroundAs in many European countries, undocumented migrants in Denmark have restricted access to healthcare. The aim of this study is to describe and analyse undocumented migrants' experiences of access to healthcare, use of alternative health-seeking strategies; and ER nurses' experiences in encounters with undocumented migrants.MethodsQualitative design using semi-structured interviews and observations. The participants included ten undocumented South Asian migrants and eight ER nurses.ResultsUndocumented migrants reported difficulties accessing healthcare. The barriers to healthcare were: limited medical rights, arbitrariness in healthcare professionals' attitudes, fear of being reported to the police, poor language skills, lack of network with Danish citizens, lack of knowledge about the healthcare system and lack of knowledge about informal networks of healthcare professionals. These barriers induced alternative health-seeking strategies, such as self-medication, contacting doctors in home countries and borrowing health insurance cards from Danish citizens. ER nurses expressed willingness to treat all patients regardless of their migratory status, but also reported challenges in the encounters with undocumented migrants. The challenges for ER nurses were: language barriers, issues of false identification, insecurities about the correct standard procedures and not always being able to provide appropriate care.ConclusionsUndocumented migrants face formal and informal barriers to the Danish healthcare system, which lead to alternative health-seeking strategies that may have adverse effects on their health. This study shows the need for policies and guidelines, which in accordance with international human rights law, ensure access to healthcare for undocumented migrants and give clarity to healthcare professionals.

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

“…This important role of NGOs, emphasised by experts in the present study, is consistent with the literature on general health care for IMs [19,38,39] and previous reports on mental health care for this group [6]. However, NGOs usually have fewer facilities than mainstream services and the quality of care might sometimes be compromised due to limited resources, as Biswas et al [40] also noted in their study on IMs in Denmark.…”

“…For example, professionals expressed uncertainty about whether to prescribe medicine or demand payment for treatment first. This was often further exacerbated by the absence of organisational policies and guidelines on how to deal with IMs [40,41]. Ethical considerations became especially important in countries where treating IMs’ mental health problems could contribute to the risk of them being reported to authorities and removed from the country.…”

Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study

“…This echoes findings from O’Donnell et al [21] and MacFarlane et al [46] that the provision of interpretation services in Ireland is inadequate. The perceived poor attitudes of primary care professionals towards patients from marginalised groups in this study resonates with findings from many other studies on this topic [32, 33, 37–39, 41, 43, 80–82]. These adverse experiences seem to deter participants in this study from attending for primary care in the community.…”

“…Communication difficulties were magnified for the migrant group, where language problems increased the frustration felt during engagement with primary care professionals; this has been described previously by Biswas et al [43] and Newbold et al [45]. None of the migrant participants in this research spoke about being offered the services of an interpreter in a primary care setting.…”

“…Patient factors such as mistrust of services and feeling unwanted have been reported for homeless people, Travellers, drug users and migrants [22, 37–41]. Other barriers seen for particular groups include legal issues for migrants and drug users [22, 42, 43], language barriers for migrants and sex workers [43–46], competing priorities for attention in the lives of homeless people [47], and accommodation issues for those living in deprivation, the homeless, Travellers, drug users and sex workers [38, 41, 48–52]. It is often noted that these barriers do not occur in isolation and that they make patients less likely to reengage with the health services.…”