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Health care for the economic immigrants in Greece
- Alexis Benos, Stathis Giannakopoulos (11 October 2000)
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Experience, behaviour and views of general practitioners in relation to refugees and asylum seekers: a survey in a region with a rising population
- Srinivasa Vittal Katikireddi, Raj Bhopal (raj.bhopal@ed.ac.uk), Julia A Quickfall (1 March 2004)
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Alexis Benos, Assistant Prof in Social Medicine, Medical Dept, Aristotle University of Thessaloniki, Stathis Giannakopoulos
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Economic immigrants coming to Greece from the neighboring countries (mainly Albania, but also Bulgaria, Romania,Georgia,etc) are today more than 500000 (the total population of Greece is 10 millions). This enormous wave of population input is not producing a, superficially, expected important rise of the health services workload. In an ongoing survey aiming the evaluation of the emergency department, we found that less than 2,5% of the average daily workload was related to immigrant population. The "healthy immigrant effect" and the following "unhealthy and heavy working conditions effects" determine the real needs of this, mainly young population. The inflexibility of the health and social services and the bureaucracy produced by the police services are constantly raising incredible obstacles to all care-seeking immigrants. The corruption generated by this situation, was recently used in a cynical way by the Ministry of Health forcing its employees to act as policemen when a "looking as immigrant" patient is seeking care. Physicians and nurses are literally obliged (with the threat of sanctions) to check in every "suspect" case, first, if the person is a legal or not immigrant, and then to proceed to the needed medical acts. If eventually he/she is found to be an "illegal" immigrant, care is denied - with the exception of life threatening conditions. Even the legal ("green card") immigrants, in the case where there is evidence for any inpatient treatment, are asked to pay half of the estimated costs beforehand! As expected this policy is producing decisively negative reactions from an important part of health workers who are disobeying in everyday practice. But unfortunately is also producing every day scenes of barbarism as was the case of a pregnant woman outside the delivery room waiting with the hope that her husband will collect, in time, the amount due for the prepayment of the service. This shameful situation is in complete contradiction with the humanistic approach with which S. Montgomery and P. Le Feuvre are struggling in order to provide decent health care services to the asylum seekers in UK1. Immigrants and asylum seekers are a reality nowadays for all european countries which can only be solved with concrete political and economic changes. As for the health and social care of these populations the only way for a human society, resisting becoming barbarian chaos, is to prove its solidarity providing the best and free of charges services available. Unfortunately the "socialist" greek government instead of following the rich tradition of public ethos and solidarity of the british society, is copying its worst moments by introducing, in its recently published reform plans, the "internal market" approach and promoting complete privatisation of the health and social services. 1. Health care for asylum seekers
Alexis Benos, Stathis Giannakopoulos, Aristotle University of Thessaloniki, Greece |
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Srinivasa Vittal Katikireddi, Final Year Medical Student University of Edinburgh, Teviot Place, Edinburgh, EH89AG, Raj Bhopal (raj.bhopal@ed.ac.uk), Julia A Quickfall
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UK asylum seekers and refugees (subsequently refugees) have equal rights to healthcare compared to the settled population. Nonetheless, in the UK, and abroad, refugees report difficulties accessing healthcare, e.g. registering with a GP 1,2. Of 50 GPs in the West Midlands, four were unsure whether asylum seekers were entitled to free treatment and two thought not3. Refugees are sometimes registered as temporary residents, detrimental for continuity of care4. Refugees may increase workloads as they may have multiple physical and mental problems, difficulty communicating and lack familiarity with the healthcare system5. With the dispersal policy, many parts of the UK are adapting to meet the health needs of refugees. Lothian has an estimated 3000 refugees. GPs in Lothian were surveyed, focussing on the need for extra funding for general practices with refugees, the best place for provision of primary care services and the need for training. Participants, Methods and Results A questionnaire was posted in early 2003 to all 129 general practices in Lothian, with a letter requesting that one GP complete the questionnaire per practice. A reminder questionnaire was sent to non- responders. The study was approved through the University of Edinburgh Medical School’s procedures for ethical approval of student-led projects. 95 responses were received (73.6% response rate). The table shows that about one-third of GPs had treated refugees; but few staff had undergone training. Of 82 GPs (86.3%) who had not received training, 17 (20.7%) wanted training, 57 (69.5%) did not, and 8 (9.8%) did not respond. Of 13 GPs who had received training, 11 had treated refugees, and 4 wanted further training. About 10% believed refugees had different entitlements to healthcare and about a quarter were unsure. Nearly one-fifth were unsure or incorrect about refugees’ entitlement to free NHS treatment. Only 44 GPs directly answered the question about registration as temporary or permanent residents. Another 9 stated this would depend on how long the refugees were residents. The remainder mainly cited lack of experience to answer. Just over 10% of responders registered refugees as temporary residents, or requested identification for registration. Respondents were divided on whether refugees should be treated at normal practices or in specialist services. Some suggested specialist centres when refugees numbers were high, but otherwise in normal practices. GPs frequently mentioned that refugees often need interpreters and more time for consultation. Most GPs felt that practices with a high caseload of refugees should receive additional funding. 55 respondents indicated what constituted a high caseload; the range being 1-100, the mean 17.5, and the mode and median 10. 31 GPs’ suggestions on funding per refugee ranged from £20-£1000, with a mean of £131.13, and a mode and median of £100. Comment GPs supported extra funding and suggested about £100 per refugee; many favoured treating refugees in normal practices; but many had no relevant training. Some were unaware of refugees’ NHS entitlements. To our knowledge, there are no published data on the views of GPs (or their international equivalent) on funding, training, and the locus of care for refugee primary healthcare. This study confirms earlier findings that requesting proof of identity and temporary registration occurs, but less than reported elsewhere3. Internationally, as in Lothian, there is a need to develop approaches to healthcare in urban centres with varying numbers of refugees. Lothian NHS Board favours a policy whereby refugees access existing services, rather than specialist services. Surprisingly, in view of the small refugee population, over a third of Lothian GPs knowingly treated refugees and this proportion will increase rapidly. Surveys such as this are needed to develop policies for primary healthcare of refugees and asylum seekers. Table GPs’ experiences, training, behaviour and views on aspects of care for refugees and asylum seekers.
*Many non-respondents to these questions cited their lack of experience with refugees as a reason for not answering. Further information gained from responses is found in the main text. References 1. Jones D, Gill PS. Refugees and primary care: tackling the inequalities. British Medical Journal 1998; 317: 1444-6. 2. Harris MF, Telfer BL. The health needs of asylum seekers living in the community. Medical Journal of Australia 2001; 175: 589-92. 3. Dar S. General practitioners’ knowledge of issues relating to asylum seekers is poor. British Medical Journal 2000; 321: 893. 4. Hargreaves S, Holmes A. Refugees, asylum seekers, and general practice: room for improvement? British Journal of General Practice 2000; 531-2. 5. Trafford P, Winkler F. Refugees and Primary Care. London: Royal College of General Practitioners, 2000. Acknowledgements Sumra Dar, Scott Murray, Judith Simms, Katie Hacking, Dr. K Rao Katikireddi, Vanisree Katikireddi. Competing interests: Julia A. Quickfall (formerly Asylum Seeker Project Co-ordinator for Lothian Primary Care NHS Trust) |
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