Discussion of the Common Barriers Causing Difficulties for Migrants to Australia When Accessing Health Care Services and the Ways Occupational Therapy Can Reduce Those Difficulties

1.0 Introduction

In 2009 it was identified that since World War II Australia has become home to over 675 000 migrants (Lamb, Whelan, & Michaels, 2009, p. 618), a majority of which encounter barriers when trying to access healthcare services that limit or completely prevent access to healthcare services (Cooke et al., 2004; Davidson et al., 2004; Davidson, Skull, Calache, Chesters, & Chalmers, 2007; Lamb et al., 2009; Murray & Skull, 2005; Perrin & Dunn, 2007; Renzaho, 2008). Cultural, language, financial, and service entitlement barriers (Cooke et al., 2004; Davidson et al., 2004; Davidson et al., 2007; Lamb et al., 2009; Murray & Skull, 2005; Perrin & Dunn, 2007; Renzaho, 2008) are most commonly encountered by migrants to Australia when accessing healthcare. These barriers are the basis of discussion in this document. The following areas will be discussed in the contents of this document, in the following order: the types of barriers and their resulting difficulties for migrants accessing healthcare in relation to culture, language, finance and service entitlements; what help is provided by occupational therapy in reducing the barriers that cause difficulties for migrants when accessing healthcare, and how occupational therapy (OT) provides the help.

2.0 Types of Barriers

There are many barriers experienced by migrants accessing healthcare in Australia. The types of barriers that come under the cultural, language, financial, and service entitlement areas have been highlighted in several journal articles (Cooke et al., 2004; Davidson et al., 2004; Davidson et al., 2007; Lamb et al., 2009; Murray & Skull, 2005; Perrin & Dunn, 2007; Renzaho, 2008) as being the main barrier areas for migrants accessing healthcare in Australia, thus the dominant barriers presented across those articles are identified under their appropriate barrier area (cultural, language, financial or service entitlement barriers) in the proceeding text of this section.

2.1 Cultural barriers

Cultural barriers include, migrant values & beliefs regarding health and family (Davidson et al., 2004; Perrin & Dunn, 2007; Renzaho, 2008), cultural differences between migrants and Australian health professionals (Cooke et al., 2004; Davidson et al., 2004; Murray & Skull, 2005), and culturally insensitive Australian health providers (Cooke et al., 2004; Davidson et al., 2004; Lamb et al., 2009; Renzaho, 2008).

2.2 Language barriers

Language barriers include migrants having little or no competence in English, lack of interpreter services, lack of multilingual healthcare professionals (Cooke et al., 2004; Davidson et al., 2004; Davidson et al., 2007; Murray & Skull, 2005; Renzaho, 2008), and lack of healthcare information written in other languages (Cooke et al., 2004; Renzaho, 2008).

2.3 Financial barriers

Davidson et al. (2004, 2007), Lamb et al. (2009), Murray and Skull (2005), Perrin and Dunn (2007) and Renzaho (2008) highlight the financial barrier that migrants cannot afford healthcare services. Renzaho (2008) identified the financial barrier of insufficient funding of healthcare services needed by migrants.

2.4 Service entitlement barriers

Service entitlement barriers identified by Department of Foreign Affairs and Trade (2008) and Murray and Skull (2005) include, most Non-Australian citizens are ineligible for Medicare assistance. Furthermore, Australian government policies reduce the capacity for migrants to access healthcare. Entitlements to healthcare services like emergent medical attention on arrival and short term trauma and torture counselling are only available to humanitarian entrants and refugees, who are the minority of migrants in Australia, which leaves remaining migrants with minimal entitlements for healthcare access (Parliament of Australia, 2009). A summary of healthcare entitlements for migrants to Australia is shown in Table 1.

Table 1

Summary of Health Care Entitlements for Australian Migrants

Note. Adapted from "Hurdles to health: immigrant and refugee health care in Australia," by S. B. Murray and S. A. Skull, 2005, Australian Health Review, 29 (1), p. 26.

3.0 Difficulties Caused by Barriers

Some of the difficulties migrants experience when accessing healthcare services resulting from the barriers identified in the preceding section are explained and discussed in the proceeding text of this section. The barriers are discussed under their appropriate barrier area (cultural barriers, language barriers, financial barriers or service entitlement barriers).

3.1 Cultural barriers

Some migrant's values and beliefs relating to family can interfere with their access to health services by reducing access to quality healthcare services, for example, Renzaho (2008, p. 229) discusses how some migrant's prefer using a family member, usually a child, as the interpreter during consultations which may reduce accuracy of information, making diagnoses and treatment difficult. Davidson et al. (2004, p. 527) states some migrant's cultural beliefs of disease and illness can cause healthcare services to delivering unsatisfactory service to them. Cultural differences between migrants and Australian health professionals, and health professionals being culturally insensitive has caused healthcare professionals to lack appropriate knowledge of migrants cultural needs (Cooke et al., 2004, p. 43) as well as lack skills required to find unfamiliar conditions in migrant children (Davidson et al., 2004).

3.2 Language barriers

Migrants that have little or no competency in English are unable to communicate with many healthcare professionals, and access appropriate information and services; this means an interpreter is essential during consultations (Cooke et al., 2004; Davidson et al., 2004; Murray & Skull, 2005). One of the most common barriers encountered by migrants is language constraints (Davidson et al., 2004), making it imperative that migrants can access information in their chosen language, access healthcare professionals with multilingual skills and access interpreter service., all of which are hard to access (Murray & Skull, 2005). With the presence of these barriers migrants are completely without healthcare services or inadequately received (Murray & Skull, 2005, p. 26).

3.3 Financial barriers

It's common