Unveiling the Patterns and Drivers of Immigrant Health Integration Policies: A Global Examination on Mipex Countries

Background and Purpose: Immigration emerges as a defining social determinant of health, with policies across numerous sectors profoundly impacting immigrant well-being. Existing studies on immigration policy typically focus on education and employment outcomes, while health policy primarily targets the general population without addressing the unique challenges among immigrants. A systematic understanding of global health integration policy, as well as clarity on the factors shaping these policies, is lacking. This study systematically examines health integration policies for immigrants in 56 countries, employing the Migrant Integration Policy Index (MIPEX) health strand data. By categorizing policy patterns and exploring their drivers, we aim to enhance our understanding of immigrant health integration policies and guide the development of more effective, context-specific policies.

Methods:

Data and Measurement: Our study utilized data from the MIPEX, which assesses a country's efforts to integrate migrants across various policy dimensions. MIPEX provides a comprehensive analysis of national-level policies, offering detailed scores for 56 countries over six continents. The health strand comprises 12 indicators reflecting the inclusiveness of health policies towards immigrants, such as health entitlements, administrative discretion, documentation, health education, and service accessibility. The data for our predictor variables came from sources including the World Bank, WHO, UNHCR, ILO, among others.

Analysis: To categorize countries based on their health integration policies, we utilized the standardized MIPEX health scores for 2014 and 2019. A model-based cluster analysis was conducted, which allows for the determination of clusters through the estimation of a statistical model. Subsequently, we conducted panel regression to identify the main drivers of health integration policies. We organized the variables into separate models to prevent multicollinearity, with each model focusing on one of three perspectives: healthcare capacity, migration dynamics, or institutional development.

Results: We observed significant diversity in policy approaches. supportive countries, such as those in North America and Western Europe, offer expansive health entitlements and emphasize migrant health research. Restrictive countries exhibit limited support, particularly in services for asylum-seekers and undocumented migrants. Selective countries provide mixed policy responses, revealing selectivity in entitlements and services. The results also indicated that healthcare expenditure, migrant acceptance indices, and national healthcare system performance are significant predictors of health integration policy orientations. We also conducted a series of robustness test to ensure the results.

Conclusions and Implications: This comprehensive investigation into immigrant health integration policies reveals a complex interplay of economic resources, social attitudes, and institutional capacities. Policy frameworks are varied and often dependent on historical contexts and current socioeconomic pressures. To combat health disparities and promote immigrant well-being, countries must consider these drivers in their policy-making processes. This research not only contributes to the understanding of health integration policy patterns but also sets the stage for future research into their long-term effects on immigrant health.