Access of migrants to Public Health. An update

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

The extension of the TSI (Individual Sanitary Health Card) to all foreign migrants in 2001 was the first step to improve their access to the public health system. After that, in 2007 the Catalan Government launched the Directive Immigration Health Plan as a brand new health policy that also aims to improve their health status. This plan establishes the main objectives to follow and fullfil the main goal. At the same time, it incorporates an educational training for all health professionals.

Neue Entwicklungen

In 2001, the extension of the TSI to all foreign migrants that registered at the council of their city village was the first step to improve their access to Public Health in Catalonia and in Spain (also see JOSEP M. JANSÀ. "Improving access of migrants to Public Health". HealthPolicyMonitor, 29/10/2004. www.hpm.org/survey/es/b4/2) . This measure was accompanied by specific strategies for maginalized populations in order to get better knowledge of their needs and consecuently to offer them better medical attention.

Following this original idea, in 2004 the Catalonian Health Plan was launched . This plan is the main tool that gives the Catalan regional government the competences to set up priorities in health care for the whole population of Catalonia. One of these goals is immigration so in 2007, the Directive Immigration Plan for Health was developed. This plan aims to define premises and values as well as strategic objectives to improve between 2007 and 2010 the health status of the immigrant population and their access to public health services .

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

This policy is completely new in Catalonia and in Spain. In  fact, several regional governments all over the country have developed their own Immigration Plan in order to offer better access to Publich Health services to immigrants. Although brand new, this policy is strongly dependent on the public health policy and services of each country. 

Purpose and process analysis

Current Process Stages

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

Initiators of idea/main actors

• Regierung

• Bürgergesellschaft

• Wissenschaft

Stakeholder positions

The Health Department of the Catalan Government has taken the leadership in the Directive Immigration Plan for Health in Catalonia that was launched in 2007. Different  associations of health professionals, migrants and NGO's strongly supported this idea from the beginning and are part of the Advisory Council. This council has the main responsibility for giving advise to the Monitorig Commission and develop, revise and assess this plan.

Actors and positions

Regierung
Health Department of Catalan Goverment	sehr unterstützend		stark dagegen
Welfare and Family Department	sehr unterstützend		stark dagegen
Locals Goverrments	sehr unterstützend		stark dagegen
Bürgergesellschaft
Trade Unions	sehr unterstützend		stark dagegen
NGO's	sehr unterstützend		stark dagegen
Migrants Associations	sehr unterstützend		stark dagegen
Wissenschaft
Scientific Socities	sehr unterstützend		stark dagegen
Medical and Nurse Associations	sehr unterstützend		stark dagegen
Other Health Professionals Associations	sehr unterstützend		stark dagegen
current    previous

Influences in policy making and legislation

After a process of setting up objetives and priorities from all groups involved in the Advisory Council, the Directive Inmigration Plan draft was evaluated by the Monitorig Comission in order to be aproved by the Catalan Health Department and the Catalan Parliament. This first Immigration Health Plan was approved in 2007 and will be in force until the end of 2010. During this time, the Monitoring Commission will be in charge of revising any change and assessing the new results.

Legislative outcome

Enactment

Actors and influence

Regierung
Health Department of Catalan Goverment	sehr groß		kein
Welfare and Family Department	sehr groß		kein
Locals Goverrments	sehr groß		kein
Bürgergesellschaft
Trade Unions	sehr groß		kein
NGO's	sehr groß		kein
Migrants Associations	sehr groß		kein
Wissenschaft
Scientific Socities	sehr groß		kein
Medical and Nurse Associations	sehr groß		kein
Other Health Professionals Associations	sehr groß		kein
current    previous

Positions and Influences at a glance

Adoption and implementation

This Immigration Health Plan develops three small plans:

1. The Recepcion Plan aims to integrate the immigrant population in their host society.
2. The Intervention Plan basically creates the mediator figure who will help migrants and health professionals to interact between each other and also to avoid language and cultural barriers. This mediator is a brand new professional inside the Catalan Public Health Service who could be required anytime by Health professionals in any centre.
3. The Formation Plan for health professionals has as its goal to teach all health professionals about cultural differences and consecuently allow them to deal with frequent problems due to these differences.

Health professionals (above all from Primary Care Units) and migrant populations are the groups directly affected by this Plan. The implementation of this plan has been and it will be succesful as long as the main obstacles (lack of public health budget and lack of time and interest of health professionals) will not interfere with the main goal.

Monitoring and evaluation

Since the extension of the TSI among the migrant population is already established and its impact on cost and efficiency has not been directly evaluated in health terms, this new Plan incorporates health indicators for immigrants:

• total access to public health,
• teenage pregnancy,
• venereal diseases,
• TBC impact ,
• etc…

These indicators (most of them shared indicators with the Catalan Health Plan) will periodically shed a light on the health status of migrants, weakness and strong points, as well as improvements. To develop these indicators, the Health Department has made a big effort to establish and expand new information technologies.

Moreover, a wide evaluation use to be made every year, and results are public and discussed among all groups involved in this Plan.

To sum up, they aim to be a real mesure of this policy impact and its cost and efficiency.

 

Expected outcome

In general, this policy will achieve its objectives considering the progresses already made, above all regarding the extension of TSI to the whole population. The main objective is to improve health status and equity for all immigrants and - following the Spanish Constitution - to guarantee public health access to the whole of the Spanish population.

However, underfinancing in the health budget, health professionals' demotivation and abusive use of health resources could be real menaces to take into account.

Impact of this policy

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

The impact of this policy will be strongly positive. It will balance oportunities among different population groups (equity) and also help the vulnerable migrant population to achieve the same level of access to public healthcare as available to the rest of Spanish population.

References

Sources of Information

• Josep M. Jansà. Agència de Salut Pública de Barcelona. "Improving access of migrants to Public Health". Health Policy Monitor 29/10/2004.
• Generalitat de Catalunya.Departament de Salut. Pla Director d'Immigració en l'àmbit de la Salut.[on line]. 1st edition: october 2006, Barcelona. Spain. Online available at http://www.gencat.cat/salut/depsalut/pdf/immidefini2006.pdf [ consultation october the 10th 2009].
• Ministerio de Trabajo y Asuntos Sociales. Plan Estratégico 2007-2010. Ciudadanía e integración. Ministerio de Trabajo y Asuntos Sociales; 2007.

Author/s and/or contributors to this survey

Patricia Fernandez-Vandellos

Empfohlene Zitierweise für diesen Online-Artikel:

Fernandez-Vandellos, Patricia. "Access of migrants to Public Health. An update". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/es/a14/2