Winning Abstracts from the 2014 Medical Student Abstract Competition: Exploring Challenges and Policy Solutions for improving access to healthcare for vulnerable populations: Lessons from the UK National Health Service
Author: Jacqueline Britz, Virginia Commonwealth University School of Medicine, Class of 2017
Background: Vulnerable populations in the United Kingdom (UK), similar to other countries throughout the world, face many obstacles to accessing healthcare. The English Department of Health is currently consulting on a proposal that may end free access to primary healthcare for some migrants, in response to concerns over budget constraints and the perceived costs and extent of "health tourism" in the United Kingdom (UK). This RESEARCH project, conducted in collaboration with Doctors of the World UK, explored the existing model of healthcare in the UK and potential implications of the proposed restrictions to healthcare. The final report presents recommendations for policymakers and key stakeholders to promote more equitable access to healthcare. The themes and recommendations that emerged from this RESEARCH project have relevance beyond the UK, and could provide valuable insights into opportunities and challenges for promoting health equity in the Unites States.
Methods: A literature review of undocumented migrants' access to healthcare in England was performed and a broad variety of stakeholders, including Members of Parliament, senior professionals from the Department of Health and Public Heath England, clinicians, and staff from charities with extensive experience with migrants, were interviewed. A coding strategy was developed integrating elements of thematic coding and framework analysis. Collection, analysis, and interpretation of data were guided by the Dahlgren and Whitehead Social Model of Health and the Commission on Social Determinants of Health Conceptual Framework.
Findings, Recommendations, and Conclusions: There are a number of factors that compromise the health of vulnerable migrants in England, including dire financial circumstances, unstable housing another living conditions, and barriers to accessing healthcare (e.g. confusion over entitlements and administrative barriers, fear, discrimination, and charging). The Government's proposal to restrict access to healthcare in England based on immigration status would threaten the health of vulnerable individuals and public health, given the importance of primary care in the prevention and early detection of infectious diseases. This proposal would also increase pressure (and consequently costs) on already over-burdened accident and emergency (A&E) departments as well as conflict with the Government's legal and ethical obligations. This report therefore recommends that the Government should not implement restrictions on access to NHS primary care based on immigration status. Interviews with experts identified several key principles of successful models of healthcare that should be integrated within the NHS structure to promote health equity, including the following: accountability and transparency, aligning incentives, collaboration and integration, effective collection and sharing of data, and changing cultural norms. This report calls for a coordinated and multisectoral strategy to addressing health inequalities in the UK, and outlines specific recommendations from which other developed countries may benefit.