Contacts between general practitioners and migrants without a residence permit and the use of ‘‘urgent’’ medical care

Abstract

Aims: To examine the extent to which general practitioners (GPs) are consulted by migrants without a residence permit (MRP), their use of the government sponsored reimbursement system and the difficulties encountered therewith. To study what hurdles the care recipients (MRP) experience in using healthcare and the reimbursement system. Methods: A written survey of GPs in the Brussels Capital region and semi-structured interviews with MRP in the same area. Bivariate analysis of the GP data (two-sided independent t-test, two-sided Fisher’s exact test). Recording, transcription, coding and categorizing of MRP interviews. Results: Overall GP response rate was 71%. The average number of MRP contacts per month was 1.1 for all, representing 0.26% of all GP contacts. GPs working in community health centres (CHC) 4.4 MRP per month (p = 0.042). The mean probability that the GP will not use the reimbursement programme is 0.66 — there is less non-use in CHC (p = 0.042). The main barrier for GPs is insufficient knowledge of the system, followed by its complex and time consuming paperwork. Barriers experienced by MRP include fear of deportation, lack of funds, insufficient healthcare-related knowledge and communication barriers. Conclusions: Primary care is an active channel in healthcare for MRP, with CHC taking the lead. With the reimbursement system, there should hardly be financial barriers to access the healthcare system. However, due to the high probability of non-use (0.66), this system cannot substantially contribute to lowering financial barriers. The complexity of the system prevents it from being used properly and leads to undesirable alternatives.