Dobbin Joanna, Burns Francesca, Casalotti Sebastian, Jaffer Mariam, Sharman Monica, Soares Catarina, Reynolds Josie
Primary care & population health, University College London, UK.
Migrant solidarity group, Medact, UK.
J Migr Health. 2024 Oct 19;10:100276. doi: 10.1016/j.jmh.2024.100276. eCollection 2024.
In 2014 the UK government rolled out the then called hostile environment as a series of punitive policies designed to disenfranchise undocumented migrants from living in Britain. As part of these measures upfront charging was introduced in 2017 which saw patients being denied treatment without prior full payment based on their immigration status.
Assess the knowledge of the charging regulations in a sample of primary care practitioners. Assess the impact of the regulations on both patients and practitioners in a primary care setting.
Building on a previous survey by the RCPCH, a cross sectional survey was circulated through the RCGP faculties and GP training groups within England. Demographic information and likert responses were collected from over 300 responses. Thematic analysis of over 120 white space questions was undertaken to create themes and sub-themes.
Results showed an overall poor knowledge of the regulations. Thematic analysis was split into two main categories, (i) human impact of the policies and (ii) the economic and political impact of the policies. Key points were (i) lack of knowledge and awareness of the regulations, (ii) evidence of patient harm through patients' being denied care, avoiding care or having care delayed, (iii) evidence of clinician harm through burnout, stress, a loss of faith in practice and concerns over extra work and (iv) concerns over implicit bias and structural racism within primary care and (v) concerns over lack of economic analysis.
Charging of overseas visitors is poorly understood within primary care despite having an impact on both patients and practitioners within this setting. Recommendations to help tackle this issue and reduce harm include training of staff, systematic reporting of harm, and a system wide economic analysis.
2014年，英国政府推出了当时所谓的“敌对环境”政策，这是一系列旨在剥夺无证移民在英国生活权利的惩罚性政策。作为这些措施的一部分，2017年引入了预先收费制度，即患者因移民身份而在未预先全额付款的情况下被拒绝治疗。
评估初级保健从业者样本对收费规定的了解情况。评估这些规定在初级保健环境中对患者和从业者的影响。
在皇家儿科学会和儿童健康学院之前的一项调查基础上，通过英格兰的皇家全科医师学院教职员工和全科医生培训小组进行了一项横断面调查。从300多份回复中收集了人口统计信息和李克特量表回复。对120多个空白问题进行了主题分析，以创建主题和子主题。
结果显示对这些规定的总体了解较差。主题分析分为两大类，（i）政策对人的影响和（ii）政策的经济和政治影响。关键点包括（i）对规定缺乏了解和认识，（ii）有证据表明患者因被拒绝治疗、避免治疗或治疗延迟而受到伤害，（iii）有证据表明临床医生因职业倦怠、压力、对执业失去信心以及对额外工作的担忧而受到伤害，（iv）对初级保健中的隐性偏见和结构性种族主义的担忧，以及（v）对缺乏经济分析的担忧。
尽管对海外访客收费对初级保健中的患者和从业者都有影响，但在初级保健中对其了解甚少。有助于解决这一问题并减少危害的建议包括对工作人员进行培训、系统报告危害以及进行全系统的经济分析。
