title: Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study.
abstract: BACKGROUND
  European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants.
  
  
  METHODS
  A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants.
  
  
  RESULTS
  The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants.
  
  
  CONCLUSIONS
  Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.
authors.affiliation: International and Migrant Health, Netherlands Institute for Health Services Research, Otterstraat 118-124, 3500 BN Utrecht, the Netherlands. w.deville@nivel.nl
authors.forename: Walter
authors.initials: W
authors.lastname: Devillé
authors.forename: Tim
authors.initials: T
authors.lastname: Greacen
authors.forename: Marija
authors.initials: M
authors.lastname: Bogic
authors.forename: Marie
authors.initials: M
authors.lastname: Dauvrin
authors.forename: Sónia
authors.initials: S
authors.lastname: Dias
authors.forename: Andrea
authors.initials: A
authors.lastname: Gaddini
authors.forename: Natasja Koitzsch
authors.initials: NK
authors.lastname: Jensen
authors.forename: Christina
authors.initials: C
authors.lastname: Karamanidou
authors.forename: Ulrike
authors.initials: U
authors.lastname: Kluge
authors.forename: Ritva
authors.initials: R
authors.lastname: Mertaniemi
authors.forename: Rosa P i
authors.initials: RP
authors.lastname: Riera
authors.forename: Attila
authors.initials: A
authors.lastname: Sárváry
authors.forename: Joaquim J F
authors.initials: JJ
authors.lastname: Soares
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Stankunas
authors.forename: Christa
authors.initials: C
authors.lastname: Strassmayr
authors.forename: Marta
authors.initials: M
authors.lastname: Welbel
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D003695:Delivery of Health Care / Q000458:organization & administration*; D003697:Delphi Technique; D054242:Emigrants and Immigrants; D005060:Europe; D006297:Health Services Accessibility; D006801:Humans; D011050:Policy Making