Ang Jia Wei, Chia Colin, Koh Calvin J, Chua Brandon W B, Narayanaswamy Shyamala, Wijaya Limin, Chan Lai Gwen, Goh Wei Leong, Vasoo Shawn
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
HealthServe Community Clinic, Singapore.
BMJ Glob Health. 2017 Mar 9;2(2):e000213. doi: 10.1136/bmjgh-2016-000213. eCollection 2017.
BACKGROUND: Low-wage migrant workers are vulnerable to healthcare inequities. We sought to identify potential barriers to healthcare and risk factors for mental health issues in non-domestic migrant workers in Singapore, and identify high-risk subgroups. METHODS: A cross-sectional, interviewer-administered survey of 433 non-domestic migrant workers was conducted at subsidised clinics and a foreign worker dormitory from July to August 2016. Questions assessed healthcare usage patterns, affordability issues, barriers to care and psychological distress using a validated screening scale (Kessler-6). FINDINGS: Bangladeshi workers surveyed were more likely to be single, have more financial dependents, a lower level of education and salary and pay higher agent fees (p<0.01). 61.4% of workers reported that they had insurance, but had poor understanding of whether it covered inpatient/outpatient expenses. The majority of workers had not, or were not sure if they had, received information about company-bought insurance (72.4%). Among those who had, most reported that information was not in their native language (67.7%). Non-specific psychological distress was found in 21.9%, as estimated by the Kessler-6 scale. Multivariate analysis found that psychological distress was independently associated with Bangladeshi nationals (OR 2.98, 95% CI 1.58 to 5.62; p=0.001) and previous experience of financial barriers to healthcare (OR 3.86, 95% CI 2.25 to 6.62; p<0.0001). INTERPRETATION: We identified gaps in non-domestic migrant workers' knowledge of healthcare coverage, and substantial financial barriers to healthcare. The Bangladeshi population in our study was at higher risk of such barriers and psychological distress. These represent areas for further research and intervention.
背景:低薪移民工人容易受到医疗保健不平等问题的影响。我们试图确定新加坡非家政移民工人在医疗保健方面的潜在障碍以及心理健康问题的风险因素,并确定高风险亚组。 方法:2016年7月至8月,在补贴诊所和外国工人宿舍对433名非家政移民工人进行了一项横断面、由访谈员进行的调查。问题使用经过验证的筛查量表(Kessler-6)评估医疗保健使用模式、可负担性问题、护理障碍和心理困扰。 结果:接受调查的孟加拉工人更有可能单身,有更多经济依赖对象,教育水平和薪资较低,支付的中介费更高(p<0.01)。61.4%的工人报告称他们有保险,但对保险是否涵盖住院/门诊费用了解不足。大多数工人没有收到或不确定是否收到过关于公司购买保险的信息(72.4%)。在收到信息的人中,大多数报告称信息不是用他们的母语提供的(67.7%)。根据Kessler-6量表估计,21.9%的人存在非特异性心理困扰。多变量分析发现,心理困扰与孟加拉国籍(比值比2.98,95%置信区间1.58至5.62;p=0.001)以及先前在医疗保健方面遇到经济障碍的经历(比值比3.86,95%置信区间2.25至6.62;p<0.0001)独立相关。 解读:我们发现非家政移民工人在医疗保健覆盖范围的知识方面存在差距,以及医疗保健方面存在重大经济障碍。我们研究中的孟加拉人群面临此类障碍和心理困扰的风险更高。这些是需要进一步研究和干预的领域。
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