Economic arguments in migration and health – a call for interdisciplinary action

Introduction

The human right to the highest achievable standard of health obliges countries to ensure universal and timely access to high-quality healthcare and to address the underlying factors contributing to health disparities [1]. Yet, access remains uneven: people with low incomes, insecure residence status or communication difficulties often face restricted access to healthcare, disadvantages that disproportionately affect and accumulate in migrant populations [2, 3]. Ensuring inclusive access is therefore not only a matter of equity but also essential for effective public health. In order to combat inequitable access to healthcare, decision-makers and other stakeholders in the field of migration and health need high-quality evidence on what works effectively and sustainably to overcome barriers, at what cost and in what context [4]. While many high-income health systems explicitly take into account health economic criteria when making reimbursement decisions, this evidence base remains comparatively limited when it comes to migration health policies [5].

In health policy debates, economic arguments are frequently invoked to frame migration as a cost pressure on public health systems and to justify cost-containment measures. For example, subsidies for translation services have been cut or user fees introduced, often on the grounds of short-term public savings [6, 7]. Such decisions typically focus on direct expenditures while overlooking potential adverse health and broader long-term consequences of inadequate communication, including increased costs associated with delayed care, medical errors, avoidable complications and additional healthcare use [8]. From both a health systems and human rights perspective, addressing language barriers is integral to quality and equitable care; neglecting them can lead to avoidable health harms and higher societal costs.

Economic arguments increasingly intersect with claims that universal health coverage is essential for global sustainable development [9]. This has shifted attention towards the costs of inaction, particularly the economic implications of excluding migrants and refugees from healthcare systems [10-13]. Yet despite growing policy relevance, robust evidence remains limited. The WHO Global Research Agenda identifies health financing for migrants and displaced populations as an understudied topic and highlights the need for studies on the cost-effectiveness of inclusion policies [14]. Thus, the economic case for equitable access to healthcare for migrants remains insufficiently developed.

This viewpoint examines how economic considerations are addressed in migration and health research and expert discourse, aims to raise awareness of critical evidence gaps and outlines the next steps required to develop robust, context-sensitive economic evidence for equitable migrant health policies.

Insights from scientific literature and experts

Discussion

Economic perspectives remain peripheral in migration and health research. The review and expert consultations are indicative that cost arguments are frequently invoked but rarely supported by robust data. Formal economic evaluations seem to be scarce, despite the fact that many studies collect data that could inform cost analyses. This suggests a missed opportunity, likely reflecting limited collaboration between economists and migration health researchers. Several factors may explain the persistent evidence gap. Disciplinary differences in language and terminology, methods and priorities can hinder collaboration. In addition, researchers may hesitate because of concerns about potential misuse of economic evidence in restrictive policy discourses, including fears that analyses might reveal high costs of care or be taken out of context to further marginalise migrant groups in increasingly hostile policy discourses [15]. Although economic arguments may appear detached from human rights principles, they can strengthen rather than undermine the case for equitable healthcare access by demonstrating both the costs of exclusion and the broader societal benefits of inclusion.

Structural and institutional factors further shape the limited economic evidence base and influence which economic questions are investigated. Health financing mechanisms may disincentivise investment in services for refugees and undocumented migrants particularly where benefits are perceived as uncertain or linked to populations seen as only temporarily present in the country. For example, economic evaluations were more common for interventions framed as benefiting host populations (e.g. communicable disease screening) than for services primarily benefiting migrant groups [16]. In addition, migrants and refugees often have a limited voice in priority-setting processes, while services for migrants are frequently funded by international agencies and NGOs rather than national governments, leading to differing decision-making criteria, responsibilities and incentives. These structural dynamics underscore the need for closer collaboration between health economists, public health professionals, anthropologists, community representatives and migration specialists, as well as for research that captures both the costs and broader societal benefits (including contributions to labour markets and social cohesion) of investing in the health of migrants, while also considering previously neglected benefits for the resident population of host countries in the short- and long-term. Promising directions for future research include distributional cost-effectiveness studies, vignette-based studies or quasi-experimental designs as well as linked administrative and routine data to inform these topics. Interdisciplinary collaboration ensures that research questions, methods, assumptions and outcomes are context-sensitive and equity-orientated. Emerging national examples demonstrate that meaningful economic analyses in migration and health are feasible using existing data [17], suggesting that progress can be made without large additional funding.

Some limitations must be kept in mind for this viewpoint. The rapid review, based on two databases and restricted to English-language sources, may not have captured all relevant studies, potentially affecting comprehensiveness and generalisability of the findings. The survey and workshop reflect perspectives from specific expert communities in migration and health and had relatively low response rates; they do not represent the full diversity of stakeholders in the field. An important next step is to engage a broader range of stakeholders, including decision-makers and health economists to advance more inclusive and policy-relevant economic analyses in the field of migration health.

Open science statement

The data presented in this study are available on request from the corresponding author.