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Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study

BACKGROUND: Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regula...

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Autores principales: Fakhoury, Julien, Burton-Jeangros, Claudine, Consoli, Liala, Duvoisin, Aline, Jackson, Yves
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160788/
https://www.ncbi.nlm.nih.gov/pubmed/35664122
http://dx.doi.org/10.3389/fpubh.2022.832090
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author Fakhoury, Julien
Burton-Jeangros, Claudine
Consoli, Liala
Duvoisin, Aline
Jackson, Yves
author_facet Fakhoury, Julien
Burton-Jeangros, Claudine
Consoli, Liala
Duvoisin, Aline
Jackson, Yves
author_sort Fakhoury, Julien
collection PubMed
description BACKGROUND: Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization. METHODS: We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors. RESULTS: Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37–5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62–6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97–1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09–1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aβ: 0.90; 95% CI: 0.31-1.77). CONCLUSIONS: This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services.
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spelling pubmed-91607882022-06-03 Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study Fakhoury, Julien Burton-Jeangros, Claudine Consoli, Liala Duvoisin, Aline Jackson, Yves Front Public Health Public Health BACKGROUND: Switzerland has a universal healthcare system. Yet, undocumented migrants face barriers at different levels that hinder their access to healthcare services. The aim of this study is to assess whether undocumented migrants' healthcare utilization improves with residence status regularization. METHODS: We used two-wave panel data from the Parchemins study, a study exploring the impact of regularization on undocumented migrants' health in Geneva, Switzerland. First wave data were collected between 2017 and 2018, second wave data between 2019 and 2020. At baseline, the sample consisted of 309 undocumented migrants, recruited after the implementation of a temporary regularization policy in Geneva. We distributed them into two groups according to their residence status 12 months before the second data collection [regularized vs. undocumented (controls)]. Using as dependent variable the number of medical consultations within two distinct 12-months periods (the first before regularization, the second after regularization), we conducted multivariable regression analyses applying hurdle specification to identify factors enhancing healthcare utilization. Then, we estimated first-difference panel models to assess change in healthcare utilization along regularization. Models were adjusted for demographic, economic and health-related factors. RESULTS: Of the 309 participants, 68 (22%) were regularized. For the 12 months before regularization, these migrants did not significantly differ in their healthcare utilization from the controls. At this stage, factors increasing the odds of having consulted at least once included being a female (aOR: 2.70; 95% CI: 1.37–5.30) and having access to a general practitioner (aOR: 3.15; 95% CI: 1.62–6.13). The factors associated with the number of consultations apart from underlying health conditions were the equivalent disposable income (aIRR per additional CHF 100.-: 0.98; 95% CI: 0.97–1.00) and having access to a general practitioner (aIRR: 1.45; 95% CI: 1.09–1.92). For the 12 months after regularization, being regularized was not associated with higher odds of having consulted at least once. However, among participants who consulted at least once, regularized ones reported higher counts of medical consultations than controls (3.7 vs. 2.6, p = 0.02), suggesting a positive impact of regularization. Results from the first-difference panel models confirmed that residence status regularization might have driven migrants' healthcare utilization (aβ: 0.90; 95% CI: 0.31-1.77). CONCLUSIONS: This study supports the hypothesis that residence status regularization is associated with improved healthcare utilization among undocumented migrants. Future research is needed to understand the mechanisms through which regularization improves undocumented migrants' use of healthcare services. Frontiers Media S.A. 2022-05-19 /pmc/articles/PMC9160788/ /pubmed/35664122 http://dx.doi.org/10.3389/fpubh.2022.832090 Text en Copyright © 2022 Fakhoury, Burton-Jeangros, Consoli, Duvoisin and Jackson. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Fakhoury, Julien
Burton-Jeangros, Claudine
Consoli, Liala
Duvoisin, Aline
Jackson, Yves
Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study
title Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study
title_full Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study
title_fullStr Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study
title_full_unstemmed Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study
title_short Association Between Residence Status Regularization and Access to Healthcare for Undocumented Migrants in Switzerland: A Panel Study
title_sort association between residence status regularization and access to healthcare for undocumented migrants in switzerland: a panel study
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9160788/
https://www.ncbi.nlm.nih.gov/pubmed/35664122
http://dx.doi.org/10.3389/fpubh.2022.832090
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