Journal of Travel Medicine
Volume 15, Issue 1, 2008, Pages 13-18
Charging systems for migrants in primary care: The experiences of family doctors in a high-migrant area of London (Article) (Open Access)
Hargreaves S. ,
Holmes A.H. ,
Saxena S. ,
Le Feuvre P. ,
Farah W. ,
Shafi G. ,
Chaudry J. ,
Khan H. ,
Friedland J.S.*
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a
Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College, London, United Kingdom
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b
Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College, London, United Kingdom
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c
Department of Primary Care and Social Medicine, Imperial College, London, United Kingdom
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d
Dover Health Centre, Shepway Primary Care Trust, Dover, Kent, United Kingdom
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e
Newham Primary Care Trust, Plaistow, London, United Kingdom
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f
St. Bartholomew's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom
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g
St. Bartholomew's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom
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h
St. Bartholomew's and The London, Queen Mary's School of Medicine and Dentistry, London, United Kingdom
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i
Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College, London, United Kingdom, Department of Infectious Diseases and Immunity, Hammersmith Hospital Campus, Imperial College, London W12 ONN, United Kingdom
Abstract
Background. There is speculation that a high number of migrants use free UK National Health Services to which they are not entitled. In response, the UK government has sought to develop and expand current overseas visitors (OVs) charging systems to target these noneligible migrants for payment. Current guidance to UK primary care providers is ambiguous, and little is known about existing procedures for dealing with new migrants. We aimed to explore the impact of OVs on primary care services and to assess the views of health-care providers about current charging systems. Methods. We undertook a 23-point semistructured questionnaire survey of family doctors working within a high-migrant area of London. Outcome measures were the following: the impact of OVs on their practices, current procedures for registering this patient group, and doctors' concerns around expanding existing charging systems. Results. Ninety-two doctors from 53 practices completed the survey (practice response rate 82.8%). Fifty-one (55.4%) of the 92 doctors reported having systems in place to identify and charge OVs requesting registration, and follow-up procedures differed across practices. Significantly more doctors [65 (70.7%)] reported not having any OVs on their practice lists receiving free consultations (p < 0.001; 298 OVs reported in total). Of the 24 (26.1%) doctors who did, this equated to approximately £3,000 monthly lost income in total for uncharged consultations across all the practices within the survey site. Seventy-eight (84.8%) doctors want a better system to identify and charge OVs in primary care but question the workability of proposals to streamline charging procedures across primary and secondary care. Concerns were raised about the implications for migrants unable to access appropriate health care and the impact on public health priorities. Conclusions. We identified variations in current procedures for identifying and registering OVs, which may result in the inappropriate exclusion of new migrants from free primary care services in the UK. Our findings suggest that the number of OVs receiving free primary care services is low. We need to explore models of appropriate health-care delivery to new migrants in the UK context, drawing on models of best practice from established health services in other migrant-receiving countries. © 2008 International Society of Travel Medicine.
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Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-38349180990&doi=10.1111%2fj.1708-8305.2007.00161.x&partnerID=40&md5=2102fa21e8c53ec54c45c051f5c113f2
DOI: 10.1111/j.1708-8305.2007.00161.x
ISSN: 11951982
Cited by: 15
Original Language: English