Woodward Aniek, Howard Natasha, Wolffers Ivan
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK, King's International Development Institute and King's Centre for Global Health, King's College London, London, WC2R 2LS, UK and Vrije Universiteit Medical Centre, Amsterdam, 1007 MB, the Netherlands.
Health Policy Plan. 2014 Oct;29(7):818-30. doi: 10.1093/heapol/czt061. Epub 2013 Aug 16.
Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps.
Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights.
Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels.
This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.
关于欧盟无证移民的健康及医疗服务可及性的文献有限，且在重点和质量方面存在异质性。作者开展了一项范围综述，以确定现有初级研究（1990 - 2012年）的范围、性质和分布情况，从而厘清已知内容、关键差距及潜在的后续步骤。
作者采用了阿克西和奥马利的六阶段范围综述框架，并结合莱瓦克、科尔昆和奥布赖恩的修订版，对已识别的资料来源进行综述。研究结果按主题进行了总结：（i）身体、心理和社会健康问题，（ii）医疗服务的可及性与障碍，（iii）弱势群体，以及（iv）政策与权利。
在识别出的598份资料来源中，纳入了54份，其中93%（50/54）发表于2005 - 2012年。来自东欧的欧盟成员国代表性不足，尤其是在单国研究中。大多数研究设计（52%）为定性研究。抽样描述普遍不佳，抽样具有目的性，仅有四项研究采用了任何随机化方法。人口统计学描述远未统一，仅有两项研究关注无证儿童和青少年。大多数（80%）纳入了关于医疗服务可及性的研究结果，报告了初级、二级和三级医疗层面的障碍。主要的可及性障碍包括恐惧、对权利缺乏认识、社会经济因素。精神障碍似乎普遍存在，而产科需求和受伤是寻求医疗服务的主要原因。孕妇、儿童和被拘留者似乎最为脆弱。虽然欧盟政策支持无证移民获得医疗服务，但实际做法仍然杂乱无章，研究报告了在地区、机构和个人层面权利的不同解释和实施情况。
这项范围综述是首次尝试描述关于欧盟无证移民健康及医疗服务可及性的现有初级证据。它强调需要开展更多且质量更高的研究，加强守门人、提供者、研究人员和政策制定者之间的合作，并减少无证移民医疗保健权利和义务方面的模糊性。
