Migration and health care in the European Union: Perceptions of access to care among migrant parents in Norfolk, England

Background: The accession of 12 new member states to the European Union in 2004 and 2007 was associated with an increase in transnational migration in Europe, particularly from poorer countries to the established Western economies. Ensuring access to health care for migrant workers and their families in the host countries can present specific challenges. This study explored experiences of migrant parents, who have recently arrived in the United Kingdom from other European countries, in accessing health services for their children.

Methods: Qualitative research methods were used. Four focus group discussions and 12 in-depth interviews were conducted with 29 migrant parents living in the town of Thetford, a relatively deprived area with a significant migrant population in Norfolk, England. Participants included recent migrants from Latvia, Lithuania, Moldova, Poland, Portugal, Russia and Slovakia. Topic guides were developed and used flexibly to explore migrants' perceptions of children health services at different levels (primary, specialist and urgent care), and to identify specific barriers migrants face in accessing services. Furthermore, we aimed to elicit how differences in health service provision and clinical practices in migrants' home countries potentially influence care-seeking behavior and health care utilization patterns in England. The interviews and focus groups were conducted in English or in participants' native languages, recorded, transcribed and translated. Thematic analysis was undertaken. The results from the qualitative research were triangulated with routine epidemiological data on utilization of health services.

Results: Lack of knowledge about entitlements to health care led to substantial delays in seeking care. Many recent migrants were not registered with a general practitioner. Communication difficulties in English presented a substantial barrier to accessing services, particularly out-of-hours, when parents were required to use telephone triage system as a first point of contact. Experiences of health care in their countries of origin influenced parents' expectations and perceptions of health services in England. Access to diagnostic investigations and specialist paediatric services in England was perceived as restricted. Parents reported travelling back to their home countries to obtain specialist paediatric care and purchase medicines.

Conclusions and policy implications: There is a need for greater awareness among health care professionals of health system differences in Europe and specific expectations, needs and barriers experienced by migrant families. Adaptation of services is required to remove linguistic, cultural and social barriers to access to care. Strengthening collaborations with migrant networks, NGOs and community volunteers are potential routes to reach marginalized communities.