Hospinnomics, Paris School of Economics, Hôtel Dieu 1 Parvis Notre-Dame, Paris, 75004, France.
Department of Sociology, University of Granada, c/ Rector López Argüeta, s/n, 18071, Granada, Spain.
BMC Health Serv Res. 2024 Nov 18;24(1):1430. doi: 10.1186/s12913-024-11926-9.
In several European Union countries, undocumented migrants face significant barriers to accessing universal healthcare. In Spain, Royal Decree-Law 16/2012 introduced restrictions that limited undocumented migrants' access to healthcare services, offering only emergency, maternal, and paediatric care. The implementation of this law created significant disparities in access to healthcare across regions. Although the law was later amended and some regions introduced alternative programs to restore access, disparities in healthcare access remain. This study aims to analyse the contribution of Community-based Health Insurance (CBHI), developed by migrant organisations, to improving healthcare access for Senegalese migrants in Spain.
We conducted 28 in-depth interviews and one discussion group across various Spanish localities between 2019 and 2022 to examine how CBHI influences healthcare access among Senegalese migrants. Using purposive sampling, we ensured diversity in participants' administrative status, sociodemographic profiles, and employment situations. Grounded theory was employed to analyse the data, focusing on the social innovation and organizational dynamics of the tontines, as well as the role migrant organizations play in facilitating healthcare access through these solidarity-based financial mechanisms.
The findings show that CBHI has emerged as a socially innovative, collective response to unmet medical needs. Through the mobilization of community funds, Senegalese migrant organizations have filled gaps left by the public and private healthcare systems, offering a crucial alternative for those excluded from formal services. Our findings also highlight the rise of transnational healthcare trends, as community insurance funds are allocated not only for healthcare in Spain but also for return and care in Senegal. This dual focus demonstrates the importance of these grassroots microfinance initiatives in enhancing healthcare access for migrants.
CBHI through tontines represents an essential community-led solution that enhances healthcare access for undocumented Senegalese migrants in Spain. Migrant organizations serve as key intermediaries, using solidarity-based microfinance models to bridge healthcare gaps left by restrictive policies. These initiatives demonstrate the capacity for grassroots innovation to address structural barriers to healthcare access in both destination and origin countries, providing a model for other migrant communities facing similar challenges.
在一些欧盟国家，无证移民在获得全民医疗保健方面面临重大障碍。在西班牙，2012 年第 16 号皇家法令 - 法律引入了限制，限制无证移民获得医疗保健服务的机会，仅提供紧急、产妇和儿科护理。该法律的实施在各地区之间造成了医疗保健获取方面的巨大差距。尽管该法律后来得到修正，并且一些地区推出了替代方案以恢复获取机会，但医疗保健获取方面的差距仍然存在。本研究旨在分析移民组织开发的社区健康保险 (CBHI) 对改善西班牙塞内加尔移民医疗保健获取的贡献。
我们在 2019 年至 2022 年期间在西班牙各地进行了 28 次深入访谈和一次小组讨论，以研究 CBHI 如何影响塞内加尔移民的医疗保健获取。我们采用了目的性抽样，确保参与者的行政地位、社会人口学特征和就业情况具有多样性。我们运用扎根理论分析数据，重点关注互助会的社会创新和组织动态，以及移民组织通过这些基于团结的金融机制促进医疗保健获取所发挥的作用。
研究结果表明，CBHI 已成为满足未满足医疗需求的一种具有社会创新性的集体回应。通过社区资金的动员，塞内加尔移民组织填补了公共和私营医疗保健系统留下的空白，为那些被排除在正规服务之外的人提供了至关重要的替代方案。我们的研究结果还强调了跨国医疗保健趋势的兴起，因为社区保险基金不仅用于西班牙的医疗保健，还用于返回塞内加尔和塞内加尔的护理。这种双重重点表明，这些基层小额融资举措在增强移民医疗保健获取方面的重要性。
通过互助会的 CBHI 代表了一种重要的社区主导解决方案，可增强西班牙无证塞内加尔移民的医疗保健获取。移民组织作为关键的中介机构，利用基于团结的小额融资模式来弥合政策限制造成的医疗保健差距。这些举措展示了基层创新的能力，可以解决目的地和原籍国医疗保健获取方面的结构性障碍，为面临类似挑战的其他移民社区提供了一个模式。
