Improving access of migrants to Public Health

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

Improvement of access into the public health network for migrants living in Catalonia whose legal situation is not all clear. It specially focuses on highly specialized interventions and drug prescriptions. Informative and sensitive actions, planning specific human and economic resources and new law regulations are included inn the strategy.

Purpose of health policy or idea

The extension of the TSI (Individual Sanitary (Health) Card) facilitating its availability to foreign migrants that registers at the council of their city or village of residence in Catalonia, which started in 2001, is now accompanied by measures that clarify the services included by the ownership of the TSI, by specific strategies for marginalized populations and by the follow up of the access of specific complementary services and medication.

The main objective of this policy is the improvement of the knowledge of this resources by migrants and professionals, offering the appropriate information instruments, as well as giving services to a broader collective of population. This policy is partially developed and at present, and it is insufficiently accompanied by financial incentives and human resources.

The final development of this policy will specially benefit foreign migrants living in non regular conditions in Spain and new comers unknowing the mechanisms of our public health system.

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

I think that this policy is bringing solutions to an evident need with big impact in  the public health network services in our country.

Political and economic background

Not yet, despite that a near change in the coming months is expected.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The idea has been growing from different statements, professionals, health institutions, migrants associations and resources linked with health needs and priorities for migrants since the beginning of the nineties.

The main purpose of the health policy idea is improving accessibility to the public health resources for all migrants living in Catalonia.

To achieve this policy, legal, administrative, and technical resources from the Catalan and the Spanish Government will be used.

The driving forces of this idea are Health Department of the Catalan Government, The Barcelona City Council, The Municipal Council of social welfare of Barcelona, other Councils in Catalonia, Universities,  NGO's and migrant associations. Those driving forces are the most related to health needs and resources for migrants.

This idea raises as the continuation of previous interventions, proposals and progresses already achieved. As examples: a) the increase of TSI (Individual Health Cards) distributed among migrants has been dramatic since 2001. b) Different agreements have also been stated between with health providers, NGO's and the Catalan Health Department.  C) A specific circuit is ready to start to facilitate the access to specialized treatments for migrants with drug addiction.

Approach of idea

The approach of the idea is described as:
amended: This measure is a reform of the previoulsy reference pricing system introduced in December 2000.

Stakeholder positions

Different groups of professionals and migrants, strongly support this idea as an essential step towards the improvement of health access. Different papers have been issued on this topic but probably there is still a lack of a more formal one. The actual leadership on the process is on the Health Department of the Catalan Government.

Influences in policy making and legislation

It's not sure to what extent this policy will be included in a specific formal piece of legislation. Probably, as far as the process reaches a final consensus with assigned resources and regulation this legislation will need to be defined. The regulation of the accessibility to the TSI as a necessary requisite for this idea, has been previously updated and modified.

Adoption and implementation

• Professionals specially from some primary care health units, and NGO's have been specially involved in the process.
• Health Agents, appropriate information actions (booklets, advertisements..) and financial resources will be needed.
• The process will be moderated  by a specific Directive Plan of the Health Department of the Catalan Government.
• Stakeholders have representation in some of the areas of the process, probably more efforts are needed in this field.
• Incentives will be the improvement of the health system, and the professionals and patients perception that specific solutions are offered for long requirements

Monitoring and evaluation

One of the main constraints for developing the proposed idea has been the existing legal regulations for migrants in our country. Some changes are expected on this field that will be essential to the development of the present idea. Undesirable effects have not been well measured. Evaluation has not been made.

Expected outcome

Considering the progresses already achieved and the increasing needs on health services for migrants the policy will probably achieve its objectives. Undesirable effects could be a abusive use of this resources by the patients and an attraction of patients living in other countries, that come to receive health services in Catalonia.

The cost in social terms will be an improvement of health status and equity for this population.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

The impact will be essentially positive, helping to balance and to give right answers in terms of health care, to vulnerable migrant populations.

References

Sources of Information

• Berra S, Elorza Ricart JM, Bartomeu N, Hausmann S, Serra-Sutton V, Rajmil L. Necessitats en salut i utilització dels serveis sanitaris en la població immigrant a Catalunya. Revisió exhaustiva de la literatura científica. Barcelona: Agència d'Avaluació de Tecnologia i Recerca Mèdiques. CatSalut. Departament de Sanitat i Seguretat Social. Generalitat de Catalunya. Maig  2004
• Real Decreto 178/2003, de 14 de febrero, sobre entrada y permanencia en España de nacionales de Estados miembros de la Unión Europea y de otros Estados parte en el Acuerdo sobre el Espacio Económico Europeo (BOE núm. 46, de 22 de febrero).

 

Author/s and/or contributors to this survey

JOSEP M. JANSÀ, Agència de Salut Pública de Barcelona

Empfohlene Zitierweise für diesen Online-Artikel:

JOSEP M. JANSÀ, Agència de Salut Pública de Barcelona. "Improving access of migrants to Public Health". Health Policy Monitor, 29/10/2004. Available at http://www.hpm.org/survey/es/b4/2