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Reducing the health care burden for marginalised migrants: The potential role for primary care in Europe

O’Donnell et al (2016) on behalf of an European funded study called RESTORE[1] Team have compared healthcare in five EU countries (Austria, Greece, Ireland, Netherlands and UK) The authors examined whether the way the health care systems, in particular primary care,  were structured and funded might support or block migrants’ access to care.

The focus on primary care by the authors was important, as “primary care is often the first point of contact that individuals have with health care

(and) can help redress inequities by acting as a gateway and co-ordinator of care to the wider health care system”.

For the purpose of this study the authors characterise “marginalised migrants” to include those who are;

  • Asylum seekers

  • Refugees

  • Undocumented

  • Victims of trafficking

  • Economic migrants in low paid work


Some of the messages and findings that the authors note from this analysis are that


Access to primary healthcare is a social determinant of health


There is “relatively little data is available of the health status of marginalised migrants”


‘ culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations’.


policymakers and practitioners need to appreciate that the capacity of individual migrants (for example how much they know about the health care system in their host country, whether they have transport to the health services), and the way health care systems are organised and funded, can be a barrier to accessing care and have a negative impact on the quality of care that practitioners can provide to such populations



The analysis showed that the diverse nature of the migrant population and found that the ability to access health care is down to multiple factors including;

·       How the new country’s health system is configured

·       Legal entitlements

·       Knowledge and awareness of the health system

·       Previous experience of health care

·       Language and cultural barriers

·       Health beliefs and attitudes


The analysis in this paper is based on an extremely difficult task of comparing very different health care models and funding arranagements, the complex and changing legal status and entitlements of marginalised migrants in different EU Member States and the evolving policy response by each of the States. The difficulty of this task is captured succinctly in the Table 6 of the Study. This table collates the findings under the 2013 Kringos Framework of Primary Care Systems which may be useful for researchers who are interested in similar comparative analyses.



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