Country-level determinants of healthcare access for refugee populations in a host country: a comparative case study

Given the unprecedented global volume of forced migration, ensuring equitable access to healthcare for refugees has become a pressing global health priority. This comparative case study examined country-level determinants that influence healthcare access and social determinants of health among refugees in Australia, South Korea, and the United States.

We conducted a comparative case study to identify country-level factors influencing refugee healthcare access in Australia, South Korea, and the United States. Countries were selected to capture diversity in geographic context, immigration and integration policies, and healthcare system structures. Data sources included a comprehensive review of laws, policies, and peer-reviewed literature, as well as in-depth interviews with refugees, healthcare providers, resettlement agency staff, and legal professionals. We used framework analysis guided by a conceptual model, incorporating both deductive and inductive coding. This study focused on cross-case themes emerging from the synthesis of all data sources.

Findings revealed that, while refugees in all three host countries generally view health services as superior to those in their countries of origin, significant disparities persisted in access across various factors. The availability of culturally and linguistically appropriate care, legal frameworks, insurance systems, and social supports varied widely, contributing to health disparities. In the United States, complex healthcare navigation and insurance gaps posed substantial barriers, while in South Korea, legal mandates for interpretation services were lacking, and health insurance coverage was limited for certain refugee groups. Australia's universal health coverage and government-funded language and interpretation services supported more inclusive access, although barriers existed for vulnerable subgroups.

This study underscores the significance of national policies, culturally competent care, and long-term integration support in promoting health equity for refugees. It also highlights the need for targeted, context-sensitive strategies to address persistent barriers and calls for better-tailored policies to support the health and well-being of refugees in host countries and beyond.