Supporting cross-cultural communication European health care: policy recommendations from the RESTORE project

Problem

Increasing migration to and across Europe means that health care systems have to meet the needs of increasingly diverse populations. Effective communication between healthcare staff and patients is a key priority. RESTORE was an EU funded project exploring ways to improve cross-cultural communication in European primary care. As part of that work, we explored the interplay between migration history, in-country health systems and policy pertaining to language and communication rights for migrants. We aimed to identify the drivers and barriers to supporting cross-cultural communication in primary care across five European setting and develop policy recommendations for supporting cross-cultural communication in primary care.

Approach

Mixed methods case studies in 5 EU countries (Austria, Greece, Ireland, the Netherlands and UK (both England and Scotland). We undertook analysis of (i) migration patterns to countries, particularly in relation to asylum seekers over the past 15 years; (ii) comparison of health care systems funding and structure and the strength of primary care systems as described by Kringos; (iii) and the level of support for language and communication within health care policies of each country. To supplement this work, we conducted qualitative interviews with elite stakeholders in European and national health organisations. Data were synthesised across case studies, informed by the theoretical frameworks of NPT and Bacchi’s approach to policy analysis.

Findings

All countries have experienced increased migration, with a marked increase in asylum applications since 2000. Migration histories, primary care systems and health policies underpin the extent to which systems promote or hinder migrants' access to primary care. Systems which require out-of-pocket payments or social insurance act as a barrier to access for marginalised migrant groups. No country provided a legal right to interpreters and policies to health care entitlement varied both across countries and by migrant status (e.g. undocumented migrants and failed asylum seekers lose many rights to access care). Structural re-organisations and austerity measures have particularly detrimental effects on access, particularly in relation to the provision of interpreting services. This impacts on health care professionals’ ability to care for such patients. Policies to support cross-cultural communication are often placed within the areas of informed consent or patient safety, in order to facilitate their implementation. Countries with strong systems of primary care seem better placed to support such strategies.

Consequences

Migrants’ rights to healthcare access and good communication must be explicitly protected when health systems are under strain. Strategies to support cross-cultural communication in health care are best placed within the patient safety agenda, supporting patients’ rights to give informed consent and participate effectively in their own healthcare. This work is now contributing the development of a European Forum for Primary Care Position Paper on primary care and migrant health.