Dr Zelalem Mengesha
Some asylum seekers in Australia are ineligible for Medicare, meaning they have restricted access to health care services and poorer health outcomes than their Medicare eligible counterparts. In NSW, these asylum seekers are allowed to access some health services under the Medicare Ineligible Asylum Seekers – Provision of Specified Public Health Services policy.
This policy was updated in November 2020 to clarify what services are available. These include emergency care for acute medical and surgical conditions; ambulatory and outpatient care required to maintain health status of asylum seekers with acute and chronic health conditions; maternity services; inpatient and community based mental health services; and ambulance transport for emergencies.
While this policy may be instrumental in reducing health inequity, its full implementation constitutes a challenge.
We conducted a qualitative study to examine the experiences of Medicare ineligible asylum seekers in accessing health care and engaging with service providers in light of the revised policy. We identified several policy and practice implications regarding the provision of health care for community-based asylum seekers.
A double burden of chronic and mental health conditions.
Accounts of both service providers and asylum seekers revealed that community-based asylum seekers in NSW have a double burden of complex physical and mental health issues, resulting from previous trauma and deprivation of healthcare, social isolation, and limited access to services while living in the community.
Delays in seeking and receiving care.
Both service providers and asylum seekers discussed that asylum seekers experience delays in accessing care for their health issues. This is due to a lack of awareness about their health care rights in NSW, fear of service fees, and the actual cost of health care.
Service providers lack awareness about the NSW asylum seeker health policy.
The study identified a lack of awareness and understanding among front line hospital staff about the NSW asylum seeker health care policy. This leads to delays in receiving care, and in some cases, outright denial of health care for asylum seekers.
The policy is “forcing asylum seekers into the emergency” department.
Participants discussed that the revised asylum seeker health policy improved asylum seekers’ access to maternity and emergency hospital care. However, gaps in the policy, specifically the lack of access to primary health care is leading to delays in receiving care, resulting in deteriorating health and ultimately forcing people into emergency departments.
Asylum seekers are heavily dependent on support organisations.
With no access to primary care, including GPs, community-based asylum seekers are heavily dependent on asylum support organisations for their health care needs. The NSW Refugee Health Service, Asylum Seeker Centre, and House of Welcome support these people by providing free health care, and advocate for their rights by writing support letters to providers which verify their asylum status and eligibility for fee waiver under the NSW policy.
Implications
Health education interventions are needed to improve awareness of health care rights among community-based asylum seekers, particularly of their rights under the updated health policy for Medicare ineligible asylum seekers.
Educational initiatives are also needed for health care providers to raise their awareness regarding asylum seekers’ health care rights, including the Provision of Specified Public Health Services policy and related care entitlements. This is critical to the success of the policy, as frontline administration staff and health care providers are often solely responsible for determining whether an asylum seeker without Medicare should obtain care.
At the policy level, significant consideration should be given to extending basic health care rights to all community-based asylum seekers in NSW and throughout Australia, irrespective of visa status. Health care policies should be extended to include access to primary care, including GPs. This is vital given the double burden of chronic non-communicable diseases and mental health conditions among community-based asylum seekers, and would reflect Australia’s established commitment to protecting the rights of asylum seekers.
Providing comprehensive primary health care to asylum seekers could reduce the need to access emergency health services, ultimately improving health outcomes and reducing the overall cost of care.
Disclosure: The original study was financially supported by the NSW Refugee Health Service.
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