Migrants in Europe are losing out on care they are entitled to

BMJ 2009; 339 doi: (Published 24 September 2009) Cite this as: BMJ 2009;339:b3895
  1. Rory Watson
  1. 1Brussels

    Most migrants do not come to Europe to benefit from the continent’s health and welfare systems, says a new report by the Médecins du Monde European Observatory on Access to Health Care.

    The report, which is based on a survey of 1218 adults without a residence permit (“undocumented migrants”) and on 93 interviews conducted in 2008, notes that only 6% of undocumented migrants cited health as one of their reasons for coming to Europe. The majority were fleeing poverty, danger, or restrictions on their freedom.

    Provision of health care for undocumented migrants varies in the 11 countries covered in the survey. In Belgium, France, Italy, the Netherlands, Portugal, and Spain the health system may cover part or all of the costs for undocumented migrants who are unable to pay. In contrast, in Germany, Greece, Sweden, and Switzerland access to free health care is largely restricted to emergency care. In the United Kingdom GPs may choose whether to register undocumented migrants at their surgery. This makes them eligible for free primary health care but not for any other medical assistance, apart from “immediately necessary treatment.”

    The report found that overall 70% of the interviewees could theoretically benefit from health coverage (this percentage ranged from 3% in Greece to 98% in Belgium), but a quarter of them were unaware of their rights.

    However, those that did seek care encountered a series of obstacles. One in every two respondents in Belgium and the UK cited administrative problems as a barrier to health care, while 40% of undocumented migrants in France and Belgium listed consultation and treatment costs. One in four cited the fear of being reported, arrested, or discriminated against as a major obstacle—a proportion that was particularly high in Sweden (43%) and the UK (40%).

    One in seven interviewees (14%) said they had been refused care the last time they were ill, with the percentage ranging from 1.3% in Greece and 5.4% in France to 28% in the UK and 33% in the Netherlands.

    In their conclusion the report’s authors, estimating that undocumented migrants represent just 1.5% of a country’s population on average, call for “a more coherent public response, along with more open and better performing health programmes to support this poorly treated group.”

    More specifically, they emphasise that health issues should remain completely independent from immigration policy. They also want to see safeguards on medical confidentiality, guarantees that children aged under 18 years and pregnant women can access preventive health care, and protection for seriously ill foreign nationals who cannot access care in their country of origin.


    Cite this as: BMJ 2009;339:b3895


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