Tjukanov, Nina; Tiittala, Paula; Salmi, Heli Healthcare for migrants in irregular situations Diagnoses and healthcare costs at a voluntary clinic in Helsinki, Finland Healthcare for migrants in irregular situations Diagnoses and healthcare costs at a voluntary clinic in Helsinki, Finland Tjukanov, Nina; Tiittala, Paula; Salmi, Heli 8 min presentation + 2 min questions

Conflicts of interest Affiliations Conflicts of interest Nina Tjukanov, MScA, midwife 1) Global Clinic, Helsinki 2) WHO, Maternal, Newborn, Child and Adolescent Health Dept. (external consultant) None to declare Paula Tiittala, MD 3) National Institute for Health and Welfare, Dept. for Health Security Heli Salmi, MD, PhD 4) University of Helsinki and Helsinki University Hospital

Universal access? Restricted access has negative public health impacts and increases healthcare costs Migrants in irregular situations have restricted access to public services in many countries of Europe, including Finland Price tag is commonly used as a counterargument for adoption of universal access policies Six Global Clinics operate in Finland Karl-Tummer et. al. Eurohealth 2010:16(1) In Finland, migrants in irregular situations are entitled to urgent healthcare at their own cost. Policy proposals for universal access to healthcare for migrants often meet opposition based on fears about costs to the public healthcare system. However, few data based on actual healthcare costs exist to support decisions. Global Clinic is a voluntary clinic in Helsinki, Finland. The once-weekly clinic offers primary healthcare services free of charge to migrants in irregular situations.

What health problems do migrants in irregular situations have? What are the costs? What health problems do migrants in irregular situations have? What are the costs? AIM: The study aims to evaluate the morbidity, service use and costs of healthcare among patients at the Global Clinic.

Cross-sectional register-based study Patient registry of the Global Clinic in Helsinki Inclusion: All visits during 2016 by age, sex, nationality, follow-up visit, reasons for encounter, type of appointment, diagnoses, treatment and referral Exclusion: Completely missing information International classification of primary healthcare (ICPC-2) Reasons for encounter and ICD-10 diagnoses converted to ICPC-2 diagnoses Conformity between study physicians was tested among 50 first encounters and algorithm for ICPC-2 conversion developed Unit costs by ICPC-2 chapters Based on national unit costs for healthcare in 2011 Correction coefficient was used to adjust for inflation from 2011 to 2016 Ethical approval obtained from Helsinki Deaconess Institute (29.10.2012)

559 visits in 2016 Figure 1. Age by sex. Figure 2. Nationalities. One third were re-visits (37%). The average age was 35 years (range 0-64). 55% of the patients were male. 71% of the patients originated from Bulgaria or Romania.

Dental concerns are common The most common ICPC-2 chapters were digestive (23%), musculoskeletal (12%) and dermatological (11%) health problems. 10% of patients were referred to urgent public healthcare. 8% of the visits were related to pregnancy and family planning. Second important observation is that during 2016 in our clinic, psychosocial problems represented only 2% of all diagnoses. The most common single ICPC-2 diagnoses were teeth/gum disease (10%), acute upper respiratory tract infections (5%), oesophagus disease (3%), hypertension (3%), pregnancy (3%), diabetes 2%, UTIs (2%), back syndrome (2%), contraception (2%), other digestive tract system disease (2%).

0.002% Total costs for treatment at the Global Clinic in 2016 was 40.000 € corresponding to 0.002 % of the total healthcare costs of public healthcare in Helsinki. 39 547,31€ in total. 71 EUR per patient. Total healthcare costs in helsinki 2,2 billion euros.

Limitations Unknown population -> Who are using the services? Morbidity? Extrapolation of costs is not possible Anonymous encounters complicate the assessment of treatment periods Possible overestimation of costs Treatment given also within the public healthcare system Possible underestimation of costs Next steps: comparison to general population Out-patient visits within the public healthcare in Helsinki as a control group Differences in health concerns? 37% were re-visits, but the proportion of follow-up visits regarding the same treatment period is not known.

Conclusions Migrants in irregular situations have diverse health problems majority of which can be treated in primary healthcare facilities The cost of primary level healthcare provided to migrants in irregular situations is relatively low More research is needed to understand the benefits of timely provided services in relation to total healthcare costs Contacts: Paula Tiittala, paula.tiittala@thl.fi Migrants in irregular situations have diverse health problems. Most of the patients did not need complex diagnostic testing or further referral.