Inequalities in access to health care: an exploration of the cascade of care for in-transit migrants and asylum seekers, and the general population in Mexico.

backgroundAll over the world, migrants experience inequalities in access to health care. While this issue has been amply explored among immigrants and refugees in high-income countries, there is a dart of information on the situation of in-transit migrants and asylum seekers (IMAS) in low- or middle-income countries. Since these are the main recipient countries for this population, it is important to document inequalities in access to care in this context, especially for countries such as Mexico, in which IMAS are entitled to health care in par with the general population.

objectiveto assess the inequalities in access to health care experienced by in-transit migrants in Mexico, as compared to the general population of Mexico, employing a cascade of care approach.

methodsWe analyzed data from a cross-sectional survey of IMAS in shelters in Tijuana (November 2020-April 2021, n=481), and from ENSANUT-COVID 2020, a representative survey of the general population in Mexico conducted at about the same time (unweighted n=25,959). We compared the cascade of care - the self-reported presence of health needs, whether participants sought care given the need, and whether they received care - of the two samples.

resultsA higher percentage of IMAS had experienced a health need in the past three months, as compared to the general population of Mexico (43.0% vs 21.9%). IMAS were less likely to seek care given the need (58.9% vs 81.8%), to receive care when they sought it (86.9% vs 97.7%), and to receive care in the public health system (19.7% vs 43.3%).

conclusionsInequalities in access to care were apparent, even in a health system that normatively should provide care regardless of migration status. Understanding why this occurs is important, and our results represent a baseline from which to evaluate future improvements in universal health coverage in Mexico.