Inequalities Limiting Health Care Access for Migrant Australians – The Positive Impact of Multiculturism and Medical Student Rotation to Remote Hospital Settings

Abstract

Limited access to public health insurance may negatively impact patient care for migrant Australians particularly those in remote hospital settings. This may reflect language and other social barriers including not insignificantly, apprehension of cost and fear of subsequent reprisal. This case reports the experience of a 26-year-old Malaysian female who presented to an emergency department with suspicion of ectopic pregnancy. Background: Globally, Australia is a major immigration target. Population data from 2020 estimate over 7.6 million migrants currently living within our borders, with many in regional or remote rural centres [1]. Access to effective healthcare is often impacted by demographic and social challenges unique to this population which include affordability and economic limitations, cultural bias and vulnerability, language barriers and alienation from the Australian Medicare system [2]. The latter, a Commonwealth government program, provides Australian citizens and selected temporary visa holders, access to a wide range of health services including hospital and outpatient treatment, pharmaceuticals and diagnostic services without cost or with subsidy by way of the Medical Benefits Schedule [3]. Patients not able to share in this scheme, may be left isolated or unfairly biased when issues of health crisis or routine self-assessment arise. We present a case report of a 26-year-old female migrant of Malaysian origin, who presented acutely to a public hospital emergency department with suspected acute abdomen. She had limited understanding of English and had no Medicare entitlement. Whilst we were able to provide care for this young woman, our ability to do so was significantly hindered by these barriers, a dilemma not uncommon in remote rural practice. It highlights the inequalities of a healthcare system that at times can have little reserve or capacity to encompass the needs of patients with cultural or social demographics that may segregate or displace them from the general population. This is all the more poignant when it occurs in a setting of limited resource and vulnerability and it demonstrates the importance of shared language skills, compliance, and a culturally sensitive and inclusive healthcare environment.