This introductory literature review provides an overview of the phenomenon of migrants' temporary travels to their home country for the purpose of receiving medical care, often referred to as "transnational health care practices" (THCP). The review explores backgrounds and reasons behind migrants' travels for health care. The reasons for such medical travels vary and include factors such as affordability, availability of specific treatments, dissatisfaction with the host country's health system, perceived better quality of treatment in the home country, language barriers, and cultural preferences.
Additionally, the study discusses the role of social class as well as social integration and its relation with the use of transnational health care. The review concludes by highlighting the need for further research to explore the specific circumstances and experiences of different migrant groups and to develop better health care provision strategies in the host countries.
Table of Contents
1 Introduction
2 Methods
3 Results
3.1 Reasons for migrants’ THCP
3.2 Research on specific aspects of transnational health care practices
4 Quality and ethics
5 Conclusions and further research
References
1 Introduction
Migrants and their use of and access to health care in their current country of residence have been studied for some time (e.g. Dias et al. 2008; Leduc & Proulx 2004). The results show that they often have no access to health care or have had negative experiences such as discrimination (ibid.). In response, many migrants make use of health care services from their home country, e.g. through the delivery of medicines, online or telephone counselling or through travelling to their country of origin (Jang, 2016). The focus of this literature review is on migrants' temporary travels to their home country for the purpose of receiving medical care. The literature refers to this practice with keywords like “medical returns” (Horton & Cole, 2011), “diaspora patients” (Hanefeld et al., 2015), “cross-border health care” (Kemppainen et al., 2018) or “transnational health care practices (THCP)” (Stan, 2015).
Medical travels of migrants are a relatively recent phenomenon, which has only been made possible to this extent by certain developments that are often associated with the process of globalisation. New information and communication technologies such as the Internet, the gradual opening of the EU labour market, technical advances in medicine and the ease of international travel are important enabling factors (Connell, 2015; Main, 2014). The internet is seen as crucial in providing information in different languages about hospitals, doctors, communities of fellow patient-consumers as well as travel options (Horsfall et al. 2013). Furthermore there have been quantitative and qualitative changes in migration patterns. The number of international migrants worldwide has increased significantly in recent years, from 173 million in 2000 to 220 million in 2010 and 258 million in 2017 (United Nations Migration Report 2017). “Migration” is defined very broadly here, as individuals and groups and their (more or less) permanent movement across political boundaries into new residential areas and communities (Scott, 2014). However, it is important to be aware of the diversity within “migration” (Horton/Cole, 2011; Main, 2014). Migration has manifold reasons, such as work, education, family reunification or flight, and individually different courses e.g. frequent relocation, simultaneous living in two countries or permanent resettlement.
Given this recent increase in and the diversification of international migration, it is essential to learn more about the migrants' health care practices in order to provide adequate health care to this growing population (Kemppainen et al., 2018). When examining this issue, it should not be forgotten that a large proportion of migrants continue to receive health care locally in the host country. However, this practice of transnational health care was found to be common among migrants across age groups, health complaints, migration durations, countries, socioeconomic and legal statuses. A better understanding of the process of migrants' THCP and underlying reasons is necessary and can help policy-makers to develop better infrastructure and services for these patients (Österle, 2013).
2 Methods
In order to reflect the current state of research in the social sciences on this topic, eight articles published in peer-reviewed journals between 2010 and 2018 were selected for systematic review. The articles were selected because they all significantly contribute to the knowledge on the backgrounds and reasons of migrants to travel to their home country for health care. Six articles can be assigned to the discipline of sociology, one to anthropology and one to human geography. They've all carried out empirical studies. Six articles used qualitative methods, mainly qualitative interviews. One paper is based exclusively on quantitative research with survey data, which was obtained through face-to-face interviews. Mixed method approaches are still fairly rare in this field, but are used by one scholar who combines a survey of 500 participants and 100 in-depth interviews. The research was undertaken in Europe, Finland, USA and New Zealand with migrants from Korea, Poland, Romania, Mexico, Russia, India and Somalia. The study participants were older than 18 years, male and female (except one study by Main (2014) with only women) and at least for one year in the new country of residence. Points where the studies differ concern the socio-economic and health insurance status of the participants, whether 2nd generation migrants were included and whether the studies were conducted in the host or home country.
In the following, the reasons for the medical travels to the country of origin identified by the reviewed articles are presented. Subsequently, further important findings of individual articles and emerging topics in this field will be discussed. Finally, the methodological approaches of the research projects are reviewed and fields for further research are identified.
3 Results
3.1 Reasons for migrants’ THCP
Transnational health care practices of migrants were first researched as a subcategory of “medical tourism” (Glinos 2010; Connell, 2011). The term “medical tourism” is used to generally refer to all people who travel from their resident country to another country with the expressed aim of accessing medical treatment (Connell, 2013). Connell (2011, p. 45) points out how this leaves migrants “hidden tourists” who remain largely undocumented and ignored by the public. Lee et al. (2010) were one of the first to argue that migrants' short trips to their country of origin for medical care cannot per se be described as tourism. They state that the deeper reasons for this particular type of medical travel must be sought. Furthermore, the term “tourism” is generally problematic in this context, as it trivialises the state of health of the given person (Main 2014).
The most frequently mentioned push and pull factors are affordability and availability (Horton & Cole, 2011; Horton, 2013; Main, 2014; Hanefeld et al., 2015). However, the authors differ in what availability relates to. It may be the (non-)availability of a health insurance plan (Horton, 2013), a specific type of treatment (e.g. in vitro fertilisation (IVF)) (Main, 2014), travel options or the (non-)availability of treatment due to excessively long waiting times (Stan 2015, Hanefeld et al. 2014). Stan (2015) draws attention to the fact that restricted access for migrants to health care can refer not only to the host country but also to the country of origin. For example, if care is linked to an employment contract in the country of origin, migrants may find themselves in a situation where they have limited access to health care services in both their old and new country. Another important factor is the experience and satisfaction with the health system in the host country (Hanefeld et al., 2015; Jang, 2016; Kemppainen et al., 2018; Main, 2014;). Higher dissatisfaction and perceived discrimination are accompanied by a greater willingness to travel to the country of origin to see a doctor (ibid.). Another frequently mentioned reason is the perceived better quality of treatment in the home country (Horton & Cole, 2011; Lee et al., 2010). Sometimes language skills and cultural conventions (e.g. not to talk openly about cancer) are barriers to accessing health care in the new country (Jang, 2016; Lee et al., 2010).
The review reveals that migrants' reasons for claiming health care in their home country go beyond these more practical, rational motives. Patients do not only travel just beyond the border somewhere in their country of birth, but they travelhome(Horton, 2013; Kemppainen et al. 2018). Lee at al. (2010, p. 109) define “home” as a feeling and a physical place. What patients refer to as home is also not necessarily related to nationality and ethnicity. Two studies have included second generation migrants who refer to themselves as “returning home” for treatment, even though it's not their country of birth (Hanefeld et al. 2015; Horton & Cole 2011).
The crucial contribution of Lee et al. (2010) to the literature is that they have found out that migrants in poor health do not only seek effective but above all affective care. This means the patient's longing for familiarity, trust, friends and family (idib.). Another motivating factor can be the patient's feeling of increased agency (Jang, 2016; Main, 2014). Migrants are familiar with several national health systems and choose what they consider to be the best options for them, so that a “patient becomes the agent of his/her cure” (Main, 2014, p. 914).
Horton (2013) points out that the act of returning for medical care is often associated with a kind of social class advancement. Through migration, many people can afford private health care in their home country that was previously unavailable to them. Medical returns are in this sense a symbolic display of migrants' newly achieved class status (ibid.).
3.2 Research on specific aspects of transnational health care practices
In their statistical analysis, Kemppainen et al. (2018) attempt to closer investigate the connection between social integration and the use of transnational health care. They used a number of categorical variables as indicators for social integration, amongst others the subjective nationality, language skills and the number of friends from the host country. They concluded that those who were better integrated into the society of the new country were considerably less likely to seek health care in their home country. Due to the complexity of the meaning and the individual perception of integration, this correlation should be further investigated.
Hanefeld et al. (2015) foreground the importance of personal networks in deciding on a particular health care provider. The descriptions in the other articles confirm this finding, almost always patients have asked their friends and family for recommendations or their opinion and have been supported by them.
Stan (2015) advocates that we should always see transnational health care practices as “embedded in a larger social context that cannot be reduced to individual level of patient motivations” (p. 347). When examining this topic, structural aspects must therefore always be taken into account, e.g. different national health systems or processes of increasing privatisation and commercialisation of health care (ibid.).
Main (2014) and Kemppainen et al. (2018) discover that migrants often use health care in their home country not exclusively, but in parallel with that in the host country. This parallel medical treatment can entail risks for the patient, e.g. by taking various drugs at the same time (polypharmacy) or by interrupting the continuity of care (ibid.)
4 Quality and ethics
Overall, all included articles have clearly formulated their research objectives and used appropriate research designs to address them. However, there are some issues that should be more strongly considered in migrants’ THCP research.
Apart from one multi-sited fieldwork project (Stan, 2015), all previous research has taken place entirely in the country of originorresidence, usually the latter. Given the transnational nature of the phenomenon, it is important to include both the country of residence and the country of origin in the considerations for a research design.
The gendered dimensions of THCP also merit more attention in the future. All except one study include women and men in their sample and do not name any significant differences in their health behaviour. Kemppainen et al. (2018) find out that single female migrants have the highest probability to use THCP. Main (2014, p. 899) interviews exclusively women because they are attributed a dominant role in providing for the health and well-being of families. Such role attributions must be critically questioned, further investigated and placed within the current gender literature.
Another point of criticism concerns the integration of research into existing literature. Only Horton (2013) contextualizes migrants' medical travels within the literature on transnational migration. In general it can be observed that the theoretical background of the studies and particularly of the researchers is often only marginally addressed (see Main, 2014 as an exception). In addition, theoretical concepts on e.g. migration, integration, inequality or transnationalism are partly omitted in the studies.
In some articles the high sensitivity of the subject as well as the fear, insecurity and pain associated for many migrants with medical travels is overlooked. For example, Horton and Cole (2011) conducted interviews in a waiting room of a hospital in Mexico. This is questionable, as some patients may have had severe pain and it cannot be guaranteed that they have not hoped for preferential treatment by participating in interviews. Patients share extremely sensitive experiences, which should be reflected in the journal articles.
The generalisation of “migrants” and their health practices is problematic. Migrant populations are diverse and include educated elites, elderly pensioners, migrant workers, refugees, asylum seekers, women, men and children.
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- Citation du texte
- Lea Lösch (Auteur), 2018, Migrants’ transnational health care practices. An introductory review, Munich, GRIN Verlag, https://www.grin.com/document/1361941
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