Migrants' health and access to healthcare in the Czech Republic.

SUMMARY The article is dealing with current state of Czech health policy in relation to migration. Overall migration information, available data on migrants' health status as well as accessibility of healthcare are provided. Some health risks connected with migration are mentioned and discussed. Authors concluded that the most urgent problem of Czech health policy in relation to migrants remains the insufficient guarantee of legal entitlement to health care. This concerns a large group of migrants with long-term residence, since the current legal regulation is disadvantageous to migrants coming from countries outside the EU. Key words: public health, migration, health status, access to healthcare, general health insurance, private health insurance INTRODUCTION As a result of discrimination, language and cultural barriers, work in low-grade positions in the risk sectors and due to living conditions on the margin of poverty are migrants considered a vulnerable group with specific medical needs (1). The issue of health and migration is becoming, particularly in developed countries, a recognised issue in developing health policy (2, 3) which should assure accessibility and quality of healthcare to migrants and to protect public health of the host country (3,4). The immigration and the relevant social processes are relatively new, but represent a significant phenomen in a traditionally homogenous Czech environment. Since the 1990s the Czech Republic (CR) is one of the countries with the fastest growing migration. In the period 1990-2006 the number of foreigners in the CR rose almost tenfold (5). Even despite a certain drop in the number of legal and long-term resident foreigners in the CR, which was caused by the economic crisis, there were more than 420,000 foreigners legally in the CR in mid-2010; that is about 4% of the population (5). It is estimated that a significant number of illegal migrants reside in the country, though their exact number is unknown. Estimates range widely from 15,000-300,000 people (6). Migrants in the CR are predominantly male - 59%. As to the nationality most numerous are Ukrainians 32%, Slovaks 18%, Vietnamese 14%, Russians 7% and Poles 6%. For a long time the composition of migrants by nationality has remained unchanged. The age structure of migrants reflects the fact that migration for economic reasons prevails and three quarters of migrants (77%) are therefore in the age category of 20-65 years. Children and young people to 19 years make up 20%, people aged over 65 make up just 3% (5). Since 1997 the number of children born to foreigners has gradually risen in the CR. All these people are potential beneficiaries of health care, while ensuring its availability is important not only for them, but for protection of public health with respect to general population as well (7). In terms of health status and accessibility of healthcare it should be considered that migrants do not form a homogenous group. There is a range of subcategories of "migrant" based on the type of migration: students, economic migrants and their families, asylum seekers, refugees, irregular migrants etc. (2, 8). The following article focuses chiefly on economic migrants and their families residing in the Czech Republic long-term and legally. Health Status of Migrants in the CR Information on migrants' health available in the CR provides only a scanty picture of health and healthcare needs of the growing number of migrants and factors affecting their health. Existing knowledge is not comprehensive enough and does not cover all groups of foreigners equally. In short, there are two basic sources of information in the CR for a description of the health of migrants. The first are routine statistics and the second are conclusions of a specific research and survey sampling (9-12). The possibility of using official statistics for describing the health of foreigners as a whole is very limited in the CR, because most routine statistics on mortality and morbidity lack data on ethnic origin. …