What is the impact of policies of exclusion on primary care attendance patterns of asylum seekers in Australia?

Problem

In Australia, asylum seekers have been subject to increasingly tough policies restricting rights of stay, and limiting work rights and access to the social safety net. Little is known about patterns of primary health service use among asylum seekers, in response to increasingly restrictive policies. We describe the frequency and reasons for attendance of newly arrived refugees from the offshore humanitarian program, and for asylum seekers who have arrived by boat without visas. We compare these patterns to the general Australian population, and in relation to changes in asylum seekers policies.

Approach

Retrospective cohort study of health care consultations of all patients of an urban refugee primary health service (date of first attendance, 1 July 2011 - 31 June 2013), until they left the service, or until 28 February 2014. Outcome measures were reasons for attendance (RFAs), classified into ICPC chapters, and compared to age-adjusted Australian general practice population.

Findings

471 persons (off-shore humanitarian entrants, 256 persons: asylum seekers, 214 persons) had 2527 consultations over 447.8 patient-years of observation. Both groups had significantly higher rates of attendance for psychological reasons than the general Australian population (off shore humanitarian entrants, 11.9/100 consultations, asylum seekers, 44.2/100 consultations). Both groups also had high attendance rates for social reasons (off shore humanitarian entrants, 33.4/100 consultations, asylum seekers, 44.1/100 consultations, an adjusted rate forty times that of the general Australian population. Asylum seekers were less likely to attend for preventive reasons, such as immunisation, than were humanitarian entrants. During this period, government policy successively limited access to refugee status assessment, work rights, and speed of decision-making for asylum seekers. Each of these policies was marked by sustained increases in attendances for social reasons by asylum seekers for basic living needs, such as food and shelter. At the end of the study period 60% of consultations by asylum-seekers included a reason arising from poverty or destitution.

Consequences

Most of the world’s refugees cross borders without visas; in Australia, of necessity this is accomplished by arriving on a boat. Australia’s policies towards asylum seekers who enter Australia this way are strict in comparison to other developed countries. Our data indicate the human cost of these measures. Asylum seekers are isolated, poor, lonely and at risk of destitution. Primary care services for asylum seekers need to provide integrated care for psychological distress and other medical care, and to mitigate through practice support the effects of policies that result in poverty and social exclusion.