Access to healthcare for undocumented migrants: analysis of avoidable hospital admissions in Sicily from 2003 to 2013

Abstract

Access to healthcare services for undocumented migrants is one of the main public health issues currently being debated among European countries. Exclusion from primary healthcare services may lead to serious consequences for migrants' health. We analyzed the risk among undocumented migrants, in comparison with regular migrants, of being hospitalized for preventable conditions in the Region of Sicily (Italy). We performed a hospital-based cross-sectional study of the foreign population hospitalized in the Sicily region between 1 January 2003 and 31 December 2013. The first outcome was the proportion of avoidable hospitalization (AHs) among regular and irregular migrants. Second outcomes were the subcategories of AHs for chronic, acute and vaccine preventable diseases. 85 309 hospital admissions were analyzed. In the hospitalized population, in comparison to regular migrants, undocumented migrants show a higher proportion of hospitalization for diseases preventable through primary and preventive care (AOR1·48, 95%CI 1·37-1·59). The proportion of avoidable hospitalizations associated with the lack of legal status is higher for vaccine preventable conditions (AOR 2·06, 95%CI 1·66-2·56) than for chronic conditions (AOR 1·47, 95%CI 1·42-1·63) and acute conditions (AOR 1·37; 95%CI 1·23-1·53). Between 2003 and 2013, the proportion of avoidable hospitalizations decreased both in regular and undocumented migrants but decreased faster for regular than for undocumented migrants. Undocumented migrants experience higher proportion of hospitalization for preventable conditions in comparison with regular migrants probably due to a lack of access to the national healthcare service. Policies and strategies to involve them in primary healthcare and preventive services should be developed to tackle this inequality.

Health of undocumented migrants in primary care in Switzerland

“…This finding has significant clinical and public health consequences. Undocumented migrants have a higher risk of hospitalization for preventable complications of chronic diseases [ 38 ]. Most migrant groups show higher diabetes-related mortality and undocumented migrants have a two-fold cardiovascular mortality rate compared to the general European population [ 39 , 40 ].…”

The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK

“…Limiting access to primary care increases A&E attendance and hospital costs 26 . A recent study in Sicily found undocumented migrants had a higher risk of avoidable hospitalisations due to chronic health conditions, compared to those with documentation 27 . To further understand the economic impact of policies restricting access to healthcare, we refer to a study in Germany which found that per capita healthcare expenditure was 40% higher among those with restricted access to primary care compared to those with regular access 28 .…”

Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre–post intervention study using medical records

“…Testing this assumption would require control sites and more data on ACS conditions and hospitalisations specifically among the refugee-seeking and asylum-seeking population. However, only little data has been published on this topic1 32 and control sites were not available in our specific case. Second, it is possible that the walk-in clinic has not been effective in addressing ACS conditions, for example, due to limitations of the specific care model and related challenges in the organisation of care 9.…”