Exploring the financial burden of health care for undocumented immigrants

Access to healthcare for undocumented immigrants remains a persistent challenge globally. In Turkey, the increasing number of undocumented immigrants has brought new complexities to the healthcare system, particularly in terms of uncompensated care. This study aims to explore the hospital visits, admissions, and uncompensated health care costs of undocumented immigrants in two city hospitals in Ankara province, Turkey. This descriptive study analyzed hospital records from 1 January 2023 to 30 June 2024. The study population consisted of foreign nationals whose hospital episodes were charged to the patient as self-paying, an administrative category used here as a proxy for undocumented status; the Ministry of Health released its utilization and cost data under official authorization, and the research team categorized and analyzed them. We used logistic regression to predict the likelihood that inpatient service costs were covered, controlling for nationality, emergency visit, intensive care admission, and average length of stay. The findings revealed that 81.4% of the total healthcare costs related to undocumented immigrants remained uncompensated. The majority of patients were from Syria, Afghanistan, Iraq, and Somalia. Emergency department visits accounted for 42.1% of total visits, while outpatient clinic visits represented 35.7%. The average unreimbursed cost per patient was calculated at $583. The provision of healthcare services to undocumented immigrants has become an increasing economic burden on the Turkish healthcare system. To facilitate access to healthcare for vulnerable groups within the undocumented migrant population, new financial mechanisms must be developed by both national and international stakeholders. In addition to financial solutions, legal and humanitarian strategies are also needed to ensure equitable access to healthcare for undocumented immigrants.