The Netherlands are known to have legislation to guarantee generous healthcare provision for UMs who cannot afford to pay the bills. In practice, however, the provision mostly of this care is limited as legislation is complex and ineffectively implemented. Service providers are often not aware of their obligations to provide care for UMs; they are uncertain about the definition of ‘necessary care’ or unaware of the provision

of reimbursement, resulting in denials of UMs particularly in hospitals.9 Because ‘proof of inability to pay’ is nowhere defined, there are great variations in billing UMs for services. The limited—and often variable—group of service providers in secondary care who are entitled reimbursement of costs of care of UMs also creates problems of accessibility. Although in principle every general practice

is available, UMs tend to cluster in a limited number of practices known for rendering this type of services, leading to a high (administrational) workload for a small group of GPs.10 Several of these practices do not keep patient records of UMs which hampers continuity of care and adequate registration of medical histories.10 Besides these barriers on the side of the care providers, UMs themselves have difficulty seeking help due to obstacles such as shame, fear of deportation and worries over bills.11 Various studies have shown that a large percentage of migrants are unaware of their medical rights and lack knowledge of the Dutch healthcare system.9 11 These problems are not exclusive to the Netherlands and have been reported in other countries as well.2 Additionally, factors such as a lack of knowledge of informal networks of local citizens and healthcare professionals, administrative obstacles, social exclusion and indirect or direct discrimination are also mentioned.12 13 Language barriers and cultural differences add to the

risk of inequity in healthcare access and quality.11 13 Studies on the accessibility of healthcare with a focus on UMs with mental health problems are scarce. Literature does exist on the perceptions of mental health, healthcare utilisation and accessibility of mental healthcare services at both national as well as international Drug_discovery level but these concentrate on migrants in general and often exclude UMs.14–18 Mental health problems Studies conducted in the Netherlands reveal that refugees and asylum seekers experience more physical and psychological problems compared to native Dutch and other Western migrants.19 20 In turn, concordant with international literature asylum seekers report more health problems than refugees who have been granted asylum.21 Among studies reporting health status of UMs in the European Union, psychological issues appear most widespread.