Hannamaria Kuusio

Background: Timely access to health services is one of the cornerstones of universal health coverage. However, various individual and structural factors remain as barriers to meet this goal. Access to physician services remains a concern for migrant populations, with a substantial proportion experiencing unmet healthcare needs, surpassing rates observed in the general population of Finland. This study aims to assess temporal changes in unmet healthcare needs among migrants in Finland across the years 2014, 2018, and 2022, investigating potential disparities across population groups. Methods: Three nationally representative datasets derived from cross-sectional surveys are used; Survey on work and well-being among people of foreign origin 2014-2015 (UTH), Survey on well-being among foreign-born population 2018-2019 (FinMonik) and National survey on health, well-being, and service use among foreign-born population 2022-2023 (MoniSuomi). We analysed data from individuals aged 20 to 64 years. Multivariate logistic regression analysis, adjusting for sociodemographic and socioeconomic factors, is employed to compare unmet healthcare needs in migrant populations with the Finnish general population. Results: A significant increase was found in unmet healthcare needs among migrant populations in Finland from 2014 to 2022. Prevalence rates rose from 25.0% in 2014 to 24.9% in 2018 and reached 33.7% in 2022. Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs. Conclusions: The escalating prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland is a cause for concern. This research underscores the urgent need for policymakers, healthcare providers, and community advocates to address healthcare inequities and ensure equitable access to healthcare, to ensure universal health coverage for all individuals in Finland. Key messages: • The prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland has escalated, compared to the Finnish general population. • Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs.

Background: Previous studies have shown that people of foreign background (PFB) often experience barriers in accessing and utilizing medical care services. This study examines the potential change in unmet health care need among PFB living in Finland in two time points: 2018 and 2022. Furthermore, we study the potential factors (age, sex, education, treason for migration and country of origin) associated with the unmet health care need. Methods: We used two nationally representative cross-sectional data sets: the Survey on well-being among foreign-born population (FinMonik, n = 6836; response rate 53.1%) in 2018-2019 and the National survey on health, well-being and service use among foreign-born population (MoniSuomi, n = 7838; response rate 44.1%) in 2022-2023. The analyses were limited to those aged 20-64-years. Our indicator for unmet health care need was based on the question: “Do you feel that you have adequately received primary care services during the past 12 months?'' Results: Unmet health care need among PFB has increased significantly between the years 2018 and 2022 (p = 0.005). The prevalence of unmet health care need among PFB was 24.9% in 2018 and 33.7% in 2022. Preliminary results show that younger age, those who moved to Finland from Middle East and Africa, refugees and Ingrains Finns reported more frequently unmet health care need. Conclusions: The increase of unmet health care need among PFB is alarming. More studies are needed to investigate the reasons behind the high rates of unmet health care need. Key messages: • Unmet health care need is an indicator of problems in access to care. • Actions are needed to improve access to care among the migrant population in Finland.

In terms of the number of respondents, Survey on Well-Being among Foreign Born Population (FinMonik) is so far the most extensive survey carried out among the population with foreign background in Finland. It comprises a wide range of self-reported data, including information on the respondent’s health, well-being and access to care, which can be widely utilized in planning and assessing integration, health and welfare policies. A mixed-method approach (an electronic questionnaire, a paper questionnaire and phone interviews) was used in collecting the data which consists of responses by 6836 respondents aged 18–64 years. All response types included, the response rate was 53.1% (n = 6836). This study describes in detail the methods used in the FinMonik survey. In addition, we describe the demographics of the respondents partaking in each response format. The aim of the study is to promote the development of mixed-method survey as a way of collecting reliable data that can be used to enhance foreign-born people’s health, well-being and access to health care. The survey responses will be used as a baseline in observing the respondents’ well-being through the register-based data available in several national registers on health, medicine use and access to care as well as the data collected in the study Impact of Coronavirus Epidemic on Well-Being among Foreign Born Population Study (MigCOVID). Furthermore, the FinMonik study protocol will be repeated every four years.

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor’s treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.

Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.

The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods.

Background: Prior studies suggest that people with foreign background (PFB) often face problems in access to health care, although access to care may vary between the different PFB groups. This study explores 1) the potential differences in perceived access to care between different PFB groups and the general population, and 2) if marital status, education, employment, self-perceived health, long-term illness, length of stay, age moved to Finland or language skills are associated with access to care among PFB. Methods: The data were gathered from the cross-sectional survey on well-being among the PFB (FinMONIK), conducted in Finland 2018. Its random sample consisted of 12 877 persons, aged 18-64 years and the response rate was 53%. Three items were used to assess perceived access to care: I was able to contact the place of care smoothly, I was able to make an appointment without undue delay and I was examined without undue delay (e.g. laboratory tests, X-ray, ultrasound). Logistic regression was used to test which factors were associated with accesses to care, adjusted for age, sex and region. Results: After controlling for age, sex and region, the results showed significant differences in access to care among different migrant groups and the general population (p < 0.001). Of those of Estonian background 37% felt that access to care was smooth while only 17% of those coming from Middle-East, and 26% of the general population. Employed persons, persons who had good self-perceived health, and people with no long-term illness, and those who had lived in Finland less than five years, had better access to health care. Marital status, education, language skills and age moved to Finland, were not associated with access to care. Conclusions: Large inequities in access to care were identified among people with foreign background. Access to services seems to be better for employed persons and those who have good self-perceived health. Key messages: Special attention should be given to improve access to care among non-employed migrants. Migrants should not be considered as a uniform group when planning services.

Background: Finland is currently undergoing a major reform of social and health care, one aim of which, is to reduce inequalities between different population groups in access to care. Previous studies showed that Finnish Roma minority are more likely to experience unjust treatment in health services and other public services in comparison to other minorities in Finland. Unjust treatment may influence health behaviors, including the use of health services, by decreasing trust towards health professionals as well as decreasing social, emotional, and physical resources. This study examined the association between experienced unjust treatment in public services and self-assessed unmet need for health care among Roma in Finland. Methods: We used data from the Roma health and wellbeing study (Roosa), conducted in Finland (2017-2018). The data was collected by the snowball method in different areas of Finland including a health examination and a structured interview. It covers 365 adults, and of those 223 (61.1%) were women. The outcome measure for unmet health care need was based on the question: “Do you feel that you have adequately received primary care services during the past 12 months?” Logistic regression was used to test the association between unjust treatment and unmet need for health care. Potential confounders were gender, age, marital status, education, employment and self-estimated health. Results: The prevalence of unmet need for health care was 37.8 percent among men and 43.7 percent among women. Those who experienced unjust treatment in public services had higher odds (OR = 6.23; p < 0,001) for unmet need for health care than those who felt treated just. This association remained after adjustments for the confounders. Conclusions: Over every third of the Finnish Roma experienced unmet need for health care. Unjust treatment seems to be a significant risk factor in access to care among Finnish Roma and its role needs further studies. Key messages: Unjust treatment in public services is an indirect indicator of systematic and/or institutional discrimination. It is important to study the extent, nature and consequences of unjust treatment and discrimination to allow vulnerable groups to be taken into account better when renewing health services.

In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an ‘active’ job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland’s GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.