Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 10, Issue 1, 2007. Pages: 43-50
Published Online: 31 Mar 2007

Migration, Mental Health and Costs Consequences in Romania

Ioana Miclutia,¹ Veronica Junjan,² Codruta Alina Popescu,³ Stefan Tigan⁴

¹ M.D., Ph.D., Associate Prof., University of Medicine and Pharmacy ``Iuliu Hatieganu'', Dept. Psychiatry, Cluj-Napoca, Romania
²Ph.D., Senior Lecturer, Faculty of Political and Administrative Sciences, ``Babes-BolyaiUniversity, Cluj-Napoca, Romania
³ Ph.D., Psychologist, Second Psychiatric Clinic, Cluj-Napoca, Romania.
⁴ Ph.D., Prof., University of Medicine and Pharmacy ``Iuliu Hatieganu'', Dept. of Biostatistics, Cluj-Napoca, Romania.

* Correspondence to: Ioana Miclutia, Second Psychiatric Clinic Cluj, 43, Victor Babes street, Cluj-Napoca 400012, Romania
Tel.: +40-264-590 127
Fax: +40-264-590 127
E-mail: ioanamiclu@yahoo.com

Source of Funding: None declared.

Abstract

This study examines the cost consequences of circulatory migrants who return to Romania for treatment after the onset of mental illness while working abroad. Socio-demographic profile, clinical history and hospitalization costs of 50 migrants consecutively admitted to the psychiatric clinic of Cluj Napoca, Romania, were evaluated. The most of the patients were young, single, with scarce experiences abroad, few social ties in host country, low-level and insecure jobs. The majority of the patients had schizophrenia spectrum disorders diagnoses. Average hospitalization cost was Euro 15.56/day/patient. Total costs were Euro 14,054.92. A 4.65 years long patient’s contribution to the health insurance (computed on the basis of minimum salary) is needed as co-payment for the hospitalization in the native country. Screening for mental illness, cultural adjustment programs, counseling points are policy measures that could tackle the issue of the management of mental illness in migrant population.

Background: Legal and illegal circulatory migration from Romania reached huge proportions after 2000, following the lifting of the visa requirements for EU Shengen countries. So far, the impact of migration on health has received scarce attention from Romanian authorities.

Aims of the Study: To describe the socio-demographic and clinical profile of the migrants who have developed mental illness, estimate their services use in terms of hospitalization and to analyze the cost impact on the Romanian health system and on the migrants' co-payments, to discuss the possible relationships between migration and mental health.

Methods: A semi-structured interview, designed by the authors, has been administered to 50 migrants admitted to the Second Psychiatric Clinic Cluj-Napoca, Romania, to investigate the following areas: immigration status, working conditions, income, housing, insurance and social bonds. The clinical symptomatology of these patients was assessed using the Brief Psychiatric Rating Scale (BPRS). The average cost of hospitalization per day per patient, the total costs of hospitalization and the migrants' co-payment through personal contribution to the insurance system were estimated.

Results: Most of the patients were young, single, with no previous experience abroad and with few social ties in the host country, with unqualified and insecure jobs. In this group, 45 out of 50 had schizophrenia spectrum disorders diagnoses. The hospitalization length of these patients was slightly shorter than the hospitalization of non-migrant patients with the same diagnosis. Individuals from rural areas had longer hospitalisation than those coming from urban areas. Those who left the country illegally and those who worked illegally had shorter hospitalisations. The average costs of hospitalization per day per patient were Euro 15.56; and the total costs were Euro 14,054.92. In order to cover the costs of hospitalization in the native country due to an illness with the onset abroad, a patient should work and contribute 4.65 years (on the basis of minimum salary) as a co-payment for the hospitalization in the native country.

Discussion: The patients considered in the present study fit the general profile of the emigrants. Discrimination, social isolation, insecurity may increase the risk for mental illness. A relevant role in the length of hospitalization may be due to the urban/rural dimension: patients from rural areas have less access to mental health care, therefore when they are finally hospitalised, they may remain longer because, in case of relapse, rapid readmission may not be possible. The shorter stay in hospital for those who left the country and worked illegally may be due to better resistance to stress and flexibility, to an illness that was not in an advanced phase, or to inability to afford higher personal co-payment for longer hospitalizaton.

Implications for Health Policies: More accurate and careful screening for mental illness should be applied at least for legal emigrants. Cultural adjustment programs should be organized prior to departure. Contact and counseling points in the host country would be important for prevention and treatment of mental illnesses. Programs focused on circulatory migrants and aimed at developing work opportunities in the native country would increase their self confidence and enable them to perceive their return as success and not as failure.

Received 28 December 2005; accepted 8 November 2006