According to the WHO European Region Health 2020 policy framework , successful governments may achieve real improvements in health if they work across government to improve health for all and reduce health inequalities. Many groups, with immigrants being one of them, have been left behind and, in many instances, as economies falter, health inequalities are growing within and between countries. Access for all, to high-quality and affordable care is considered one of the milestones towards an equitable, sustainable and of high quality health system.
Greece has been traditionally a country which sent immigrants to rapidly developing countries. However, since the early ‘90s it has transformed into a country which hosts immigrants, mainly from the Balkans . In 2009, 958.000 immigrants (both documented and undocumented) were estimated to be living in Greece comprising 9% of the population . Most of the immigrants are coming from Albania (58%) and countries from Eastern Europe (Ukraine, Moldavia, Georgia etc.) at a percentage of (14%) while immigrants from Asia and Africa are estimated to be 10% of migrant population.
Evidence shows that immigrants are more vulnerable to social and economic disadvantage, something that affects health outcomes as well as access to health care [4, 5]. In particular, social exclusion is closely linked to migration . Socially excluded are defined by the same authors, as those who are marginalised and stigmatised due to their distinguishing characteristics (e.g. low paid wages). These groups are more likely to be excluded from a number of social and community life aspects such as participation in civil society, lack of or inadequate provision of social goods (e.g. language services), education and healthcare, and exclusion from social production and consumption. As far as healthcare is concerned, immigrants usually face obstacles and difficulties in accessing the health services of the country of their residence as well as the quality of any services provided. European Union authorities have pinpointed the specific problem and have stressed the need for application of national policies for tackling it .
The health care system in Greece is linked to employment status and type of employment. The newly created National Health Services Organization was intended to cover the vast majority (more than 95%) of the population (workforce, dependents and pensioners), assuming the presence of only short-term unemployment. The basis for entitlement is insurance status. Regarding entitlement of migrants to health services, as stated in a study  conducted for the policies on health care for migrants in EU 27 “migrants legally residing in the country enjoy the same rights as citizens in terms of access to the healthcare system. The requirement however is to have insurance, as they cannot claim the welfare benefit, nor the card which allows persons with low income free access to healthcare. Free (or subsidized) healthcare is strictly connected to affiliation to a social insurance. Only legal aliens, namely those holding a residence and employment permit, have a right to social insurance”.
However, in the context of the deep crisis, unemployment rose rapidly since 2009 to reach 26.8% in January 2013. Under pre-existing legislation, EOPYY only effectively covers the unemployed for a maximum of two years, thus leading to a rise in the percentage of the uninsured population and migrants, as a vulnerable group, are mostly affected by that economic turmoil.
Even though scientists and health policies are continually dealing with the issue of inequalities in health care [9, 10] there is not clear evidence about the health status of the approximately one million immigrants living in Greece today and their accessibility to healthcare services. Although immigrants are considered as a high risk group, vulnerable to poverty and social exclusion, there is a lack of an in-depth analysis and documentation of the factors that lead to this situation.
Until today, there hasn’t been a formed policy regarding the access and use of health care services mainly due to a lack of sound data for the epidemiological profile of immigrants and the use of health services by them. Therefore the development of any health care policy for immigrants must be evidence-based on health care needs of immigrants. Additionally, information is needed regarding the extent that the immigrants have access in health services and if that access is of satisfactory quality. Inevitably studies regarding the health literacy and use of health care services are essential.
This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece. The present project aims to fill a gap by investigating the perceptions of immigrants from developing countries on barriers to healthcare access in Greece and proceed to specific proposals regarding the best ways to enhance the access of these groups in health care services.