Background: Health assessments (HAs) for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how they are organized, and whether it is mandatory or not to attend varies between countries. Swedish national statistics have shown that only about 45% of asylum seekers attend the optional HA offered upon their arrival in Sweden. There are significant variations among Sweden's 21 counties, ranging from 20 to 90%. The reasons for the low attendance have not yet been fully explored, though there are indications of structural weaknesses within the healthcare system. This study aimed to identify variations in policies and implementation of HAs targeting asylum seekers and other migrants. The study analyzes the structure and processes in different Swedish counties and discusses how this might influence the coverage. Methods: This research project had an exploratory quantitative descriptive design applying a cross-sectional survey based on two structured questionnaires. Descriptive statistics were performed to summarize the data. Results: The number of healthcare centers in each county that carried out HAs on asylum seekers varied independently of the size of the county. Variations in regard to structure, organization, processes, and performance monitoring of the HA process also appeared diverse, and these were in some cases also reported differently by administrators and healthcare professionals in the same county. Most commonly, the HAs were carried out in ordinary health centers, though some counties presented alternative solutions on how to organize the HAs. Conclusions: There seems to be no coherent national system for carrying out HAs on asylum seekers in Sweden. The structure, organization, processes, and outcomes vary between the counties, and the reasons for the low coverage of HAs appear to be multifaceted. © 2018 The Author(s).

Migrants Asylum seekers Sweden Health system Health assessment

Health Personnel refugee methodology Research Design health care personnel human Refugees statistics statistics and numerical data organization administrative personnel Cross-Sectional Studies asylum seeker Surveys and Questionnaires Sweden cross-sectional study Humans male female questionnaire Health Knowledge, Attitudes, Practice Article exploratory research human experiment migration patient attitude Patient Acceptance of Health Care health care system Transients and Migrants quantitative analysis health center monitoring Facilities and Services Utilization Organizations Physical Examination structured questionnaire attitude to health