Imported Infectious Diseases

The Impact in Developed Countries

Fernando Cobo

• Publisher: Woodhead Publishing
• Year: 2014
• Print ISBN: 9781907568572
• eBook ISBN: 9781908818737
• Topic: Medicine
• Subtopic: Infectious Diseases

The increase of immigrant population in developed countries (mainly in Europe and North America) together with an important increase of international travel worldwide are the two most important causes that have contributed to the introduction and diagnosis of imported/tropical infectious diseases in these countries. These factors have had an important impact in developed countries in both social and economic aspects. Imported Infectious Diseases focuses not only on describing the infections, but also in evaluating the current epidemiology, the economic and social impact and the possibility to apply immunization measures and vaccines. The main purpose of this book is to give an overview of the current most important and frequent imported infectious diseases in developed countries. The first chapter informs about the medical services that are being offered to the immigrants in the main developed countries depending on the legal situation. Following chapters describe the main surveillance systems for these kinds of diseases, mainly in Europe and North America. Finally, remaining chapters contain sections on epidemiology, pathogenesis, clinical features, diagnosis, treatment and prevention.

1

Introduction

Abstract

It is difficult to determine the true impact of unauthorised immigration on uncompensated healthcare costs. This impact is not uniformly distributed between different countries, or even within countries among regions and individual healthcare providers and hospitals. The rate of uninsurance is higher among immigrants than the native-born population, but usage of healthcare services by immigrants is significantly lower than that of native-born people. However, uncompensated care costs are a serious problem for the healthcare system in certain countries, such as the US and several European countries, particularly in those with large numbers of un-insured or illegal immigrants.

Key words

Immigration

healthcare costs

health insurance

illegal immigration

immigration policies

uninsurance

1.1 The real problem of the immigration phenomenon

Current policy discussion about immigration generally focuses on two key issues: the true impact of immigration on the economy, including health insurance costs; and its social and cultural importance. The social and cultural impact of immigration, in general, has usually been seen as a negative factor because immigrant populations may disrupt coherence to communities and undermine the sense of national identity. On the other hand, the economic impact is a strong positive factor in most of countries, especially in countries with older populations that can benefit from migrant workers.

There are also economic arguments against immigration. Policy makers must balance the economic need for immigrants against the social problems that a massive wave of immigration might create in some communities. Developed countries that require workers have always been the primary driver of immigration. Both legal and illegal immigration levels are closely related to changes in the global economy, increasing during economic booms and decreasing during time of recession.

Illegal immigration into the US and several countries on Europe is a current phenomenon. More than ten million undocumented people reside in the US, and there are similar numbers in Western Europe.

Typically, illegal immigrants enter developed countries for better jobs; sometimes they are refugees from wars in their home country (especially those from Africa). However, illegal immigration can cause serious security problems in these countries. Even although they are not directly involved in such problems, the presence of millions of undocumented immigrants without resources may lead to alterations in the law, distraction of resources, and create a background for criminals and delinquency. For these reasons, many experts in the field believe that the real problem presented by illegal immigration relates to security rather than the economy. Furthermore, illegal immigration undoubtedly has a ‘called effect’ for other illegal immigrants, and encourages the culture of illegality.

1.2 Immigration health costs in developed countries

Besides the problem of security in countries with massive illegal immigrants, there are economic costs. One of the most important of these is the healthcare cost, which is frequently cited as a reason for limiting immigration.

Uncompensated care costs result when patients are provided with healthcare services for which no insurance or other payment is made. These costs are then taken on by healthcare providers, health public system and some hospitals. No comprehensive and accurate data is available yet about the impact of authorised immigrant on uncompensated care costs in developed countries. The link between illegal immigrants and uncompensated care costs is based on the assumptions that the majority of unauthorised immigrants are not insured and that unauthorised immigrants receive critical care in hospitals and thus contribute significantly to uncompensated care costs.

These increased healthcare costs are not uniformly distributed among countries, or even among regions or hospitals within countries. Some unauthorised immigrants obtain insurance through an employer, and the majority of uncompensated hospital care costs are not clearly attributable to unauthorised immigrants.

Immigrants use significantly less healthcare services than native-born citizens. Among immigrants with public insurance, the value of healthcare services was 45% lower than that of native-born citizens. Also, the value of healthcare services used by uninsured immigrants was 60% less than that of uninsured native-born people.

In the US, more than 40% of non-US citizens are without insurance. Each immigrant’s access to health insurance depends on their legal status, education and the length of time they have spent in the US

With regard to healthcare costs, uncompensated health costs were estimated at 38–40 million dollars in the US in 2001. Public funds cover up to 85% of these costs, decreasing investments in other public services.

1.3 Health assistance in immigrants: comparison of several countries

Healthcare utilisation varies among developed countries. Some differences might reflect lower take-up of new medical technologies, as well as the policies through which access to medical services is controlled. Many developed countries, mainly in the US and Western Europe, have recently taken in numerous immigrants. Currently, there are close to 30 million immigrants in the US and constitute 10–15% of the total population, thus the fight against illegal immigration is at the moment a priority for all developed countries. The last decades have seen tightening of national legislations, with increases in border control, identity checks, workplace inspections and return of illegal immigrants to their original countries. According to the International Labour Organization, in 2010 there were four and a half to five million illegal immigrants living in Western Europe. However, European countries have contributed equally to this phenomenon, and certain countries are the preferred destinations for many immigrants, such as Germany and the UK.

Immigrants may use different healthcare services depending on which country they are in, because each has different policies with regard to attending to immigrant people. Countries also vary in their acceptance of immigrants, and cultural difference between immigrants and natives are greater in some. The importance of determinants of healthcare use may differ according to type of medical care, and the country. For example, it is well known that the use of emergency services can be a consequence of barriers in primary healthcare, or of level of satisfaction with primary care providers.

1.3.1 Health coverage in the United States

All legal permanent residents and other legal immigrants had the same access to public benefits, including medications. After some legal reforms in 1996, states had many health policy options related to immigrants. Of the six states with the largest immigrant populations, only California decided to include immigrants in all its health programs, including medication, even although this state receives no Federal funds to do so.

Immigrants account for approximately 20% of the 44 million uninsured people in the US. Of the nine million low-income non-citizens, over 58% have no health insurance and only 15% received medication. In contrast, about 30% of low-income citizens are uninsured and almost 30% have received medication.

Health coverage for immigrants also varies depending on where the immigrants come from. Half of immigrants from Mexico are uninsured compared with 20% of those from Cuba, Russia and the Philippines. Only 15% of immigrants from Mexico have coverage, whereas almost 40% of Cuban and Russian immigrants are covered. Barriers to coverage and health services for immigrants include issues related to language, discrimination and misinformation.

In summary, immigrants in the US have low health coverage and fewer health services than native-born US citizens, and low-income immigrants are the most uninsured population in the country. Children born in the US in immigrant families are more likely to be uninsured.

1.3.2 Health coverage in European countries

In Western Europe, almost half the countries require a fee for medical services as part of their national health system, and this might reduce use of healthcare services among all people, especially the immigrant population.

There are some differences with regard to access to publicly funded healthcare services for immigrants in countries of the European Union (EU). Countries such as Belgium, Germany and the Netherlands have Social Health Insurance (SHI) systems, whereas Spain, Italy and the UK have tax-financed National Health Services (NHS). In general, healthcare providers in SHI systems belong to private organisations; physicians are paid a fee for their services. In contrast, NHS systems belong to the public sector and doctors are paid by means of a monthly salary.

In Belgium, the fees for physicians and specialists are usually paid in advance, in full, by patients, thus immigrants are always required to pay. However, the costs of providing urgent medical care to an immigrant are paid by the providers and then reimbursed by the Social Welfare Centre.

In Germany, the fees for medical care are paid by health providers, but in the case of communicable diseases such as tuberculosis or sexual transmitted diseases, which are an immediate risk to public health, public health offices and publicly subsidised private medical centres will treat uninsured people free of charge (but this does not apply to AIDS treatment). All public employees are obliged to denounce any illegal immigrant to the authorities.

In the Netherlands, any illegal immigrant who is not a lawful citizen cannot claim any benefit in social security, such as healthcare assistance. However, there are two situations in which illegal immigrants can reclaim these services, namely the provision of care in emergencies, and for diseases of public health importance.

In the UK, people who are ordinarily resident in the country, including legal immigrants, are completely covered with regard to medical services, while non-citizens, including illegal immigrants, who require medical treatment are subject to the provisions of the NHS. These patients are not charged for the treatments they receive, but further treatments might be chargeable, other than in the case of certain communicable diseases (excluding AIDS, or HIV infection).

The healthcare system in Italy is based on a NHS that provides universal coverage free of charge at the point of service. Immigrants in Italy have the right to receive urgent and essential primary and hospital care due to any disease or accident.

Finally, in Spain all healthcare services are free of charge, but since 1991 all patients have been required to have an individual health card. Immigrants must be registered in their local census, as well local citizens, in order to have the same rights. Complete coverage of medical services is provided for unregistered immigrants if they are below the age of 18 years and for women who are pregnant, in labour and during the post-partum period. Care is provided for people with severe diseases and after accidents. No reference is made to unregistered immigrants with communicable diseases.

Immigrants represent around 1% of the people residing in the EU. Measuring rates of public healthcare resources by immigrants is not easy but immigrants appear, on average, to be using health services at a lower rate than the rest of the population. A major problem in many developed countries...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright page
• List of figures
• List of tables
• Acknowledgements
• Preface
• About the author
• 1: Introduction
• 2: Epidemiology of infectious diseases in immigrants
• 3: Surveillance systems for tropical infectious diseases in developed countries
• 4: Febrile syndrome in immigrants and travellers
• 5: Diarrhoea syndrome
• 6: Current status of malaria
• 7: Filariasis
• 8: Schistosomiasis (bilharziasis)
• 9: Strongyloidiasis
• 10: Trypanosomiasis
• 11: Taeniasis and neurocysticercosis
• 12: HIV infection
• 13: Syphilis
• 14: Tuberculosis: the problem of multiresistance
• 15: Viral hepatitis
• 16: Leishmaniasis
• 17: Viral haemorrhagic fevers
• 18: Arthropod-borne viruses affecting the central nervous system
• 19: Prophylaxis, immunisation and vaccination
• Index