VCU news

By Anne Dreyfuss
C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Charging immigrants in England for health care could cause people to delay seeking medical attention, leading to public health threats and increased health care costs down the road, according to a study by a third-year Virginia Commonwealth University School of Medicine student. The study, which was led by 26-year-old Jacqueline B. Britz, was published in Oxford University Press’ Journal of Public Health.

As a public health graduate student at the London School of Hygiene and Tropical Medicine in 2013, Britz did her thesis project on the effects of a U.K. Department of Health proposal to introduce charging undocumented immigrants for primary health care. At the time of her research, primary care was free for immigrants through the National Health Service, but the country was considering changing that policy because some argued that it would discourage people from immigrating solely to access free health care.

In conducting research for the study, Britz worked with Doctors of the World UK, which is a humanitarian nonprofit organization that provides emergency and long-term medical care to vulnerable populations while advocating for equal access to health care worldwide.

After consulting with clinicians, members of Parliament, officials with the U.K. Department of Health, and other experts on vulnerable populations in England, Britz concluded that the proposal could affect more than 1 million people. That population would abstain from seeking medical attention for preventable and treatable conditions until the issue became urgent, thus putting the entire country at risk for public health outbreaks and costing more for the health care system overall. She also found that the vast majority of people are not coming to England for health care reasons. Only about 2 percent of those surveyed listed health care as a consideration for moving to the U.K., and most people had been in the country for about three years before even accessing services.

Before Britz’s study was published in April, the Immigration Act was revised in May 2014 to extend health care charges for immigrants. Following strong lobbying efforts by advocacy groups, however, the changes have not yet been implemented.

If charging migrants for primary health care is implemented, we need to collect data to understand its implications and to ensure that those who are most vulnerable are not restricted from accessing medical care when they need it.

“If charging migrants for primary health care is implemented, we need to collect data to understand its implications and to ensure that those who are most vulnerable are not restricted from accessing medical care when they need it,” Britz said. She added that the study’s findings have worldwide implications, including in the U.S. given the continuing debate surrounding the Affordable Care Act and Medicaid expansion. Those who are not poor enough to qualify for Medicaid, but who don’t qualify for subsidies under the Affordable Care Act, are caught in the middle under the ACA and will be denied health care if Medicaid is not expanded, Britz said, much like what is happening to the population of immigrants in the U.K.

“I am a firm advocate for access to health care for all populations,” Britz said, adding that she was attracted to VCU School of Medicine based on the school’s focus on meeting the needs of underserved populations. Britz is involved in the International/Inner City/Rural Preceptorship program, which prepares student doctors to provide quality, compassionate care to medically underserved populations. She also volunteered on a School of Medicine medical relief trip to Peru last summer.

Britz plans to integrate the public health degree she earned in London with her medical training at VCU to practice primary care for underserved populations after graduating in 2017.

“I like the idea of being the first point of contact for underserved populations,” Britz said. “I could see myself providing primary care at a free clinic in an urban setting.”