ACCESS TO HEALTHCARE FOR MIGRANTS IN AN IRREGULAR SITUATION

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1 ACCESS TO HEALTHCARE FOR MIGRANTS IN AN IRREGULAR SITUATION Vienna, 1 March 2012 FRA premises, Schwarzenbergplatz 11, 1040 Vienna Introduction In the past few months the Fundamental Rights Agency (FRA) has on various occasions drawn attention to the situation of migrants in an irregular situation and in particular to their difficulties in accessing healthcare. The FRA launched the following reports on the topic in 2011: Migrants in an irregular situation: access to healthcare in 10 European Union Member States: egular-migrants-healthcare_en.htm Fundamental rights of migrants in an irregular situation in the European Union The issue was also the topic of the 2011 Fundamental Rights Conference, co-organised together with the Polish EU Presidency ( and of the Annual Dialogue organised by the European Union Committee of the Regions and the FRA ( conclusions.pdf). Overall purpose of the meeting The purpose of the meeting is to discuss possibilities to facilitate access to basic healthcare services for irregular migrants, which go beyond pure emergency care, by identifying necessary points for intervention at the national as well as EU levels. The discussions will consider particularly arguments related to public health and cost effectiveness. The meeting is focussed around the findings of the FRA s research on access to healthcare for irregular migrants. Access to certain basic forms of healthcare should not depend on a person s legal status. If certain categories of persons living in the community are excluded from healthcare, including access to preventive medicine, this can also have consequences for the community at large. Furthermore, if access to primary or preventive healthcare services is excluded or limited, individuals are likely to approach healthcare facilities for more costly emergency treatment.

2 FRA research on access to healthcare for migrants in an irregular situation Entitlements to healthcare The entitlement to healthcare for migrants in an irregular situation is unevenly provided in the EU Member States. In 19 out of 27 EU Member States migrants in an irregular situation are entitled to emergency healthcare only. However, in 11 out of these 19 countries migrants in an irregular situation are entitled to emergency healthcare but have to pay for it. Delivery is considered an emergency in all Member States and medical staff may not refuse to treat irregular migrant women who are in labour. However, there may be costs for childbirth and only some Member States provide full access to ante- and post-natal healthcare. In spite of their particular vulnerability, only in five EU Member States irregular migrant children are entitled (up to a certain age) to the same level of access to healthcare as nationals. Special rules apply with regard to cost-free screening for contagious diseases, which may be available free of charge due to public health concerns. However, the treatment may not be provided cost-free. Based on the findings of the research, the FRA is of the opinion that migrants in an irregular situation should, as a minimum, be entitled by law to access necessary healthcare services. Such healthcare should not be limited to emergency care only, but should also include other forms of necessary healthcare, such as the possibility to see a general practitioner or receive necessary medicines. The same rules for payment of fees and exemption from payment should apply to migrants in an irregular situation as to nationals. Migrant women in an irregular situation should have access to reproductive and maternal healthcare services, at the same level as nationals, in light of Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women and Article 24 of the Convention on the Rights of the Child (CRC). Likewise, children in an irregular situation are entitled to the same healthcare services as nationals, in light of Article 24 of the CRC. To cover the costs, public health insurance should be extended to migrants in an irregular situation or a separate fund should be created. Obstacles preventing access to healthcare services for migrants in an irregular situation The FRA research identified a number of obstacles preventing access to healthcare for migrants in an irregular situation and formulated opinions on these. They relate to: Complicated procedures for reimbursement of the health provider for the healthcare given to the irregular migrant. The FRA suggests that EU Member States should establish simple and effective reimbursement procedures. Requests for reimbursement should be processed quickly. The fear of being detected based on real or perceived exchange of data between healthcare providers and immigration enforcement bodies results in irregular migrants delaying seeking healthcare until an emergency arises. This has negative consequences for the health of the individual and results in more expensive interventions. Therefore, the FRA considers that EU Member States should disconnect healthcare from immigration control policies and should not impose a duty to report migrants in an irregular situation upon healthcare providers or authorities in charge of healthcare administration. 2

3 For accessing healthcare the irregular migrant may be required to reveal his/her identity, which represents a major obstacle when seeking access to healthcare. The FRA suggests that qualifying conditions, such as the need to prove a fixed residence or prolonged stay over a certain period of time, should be reviewed or applied in a manner which does not exclude persons in need of necessary medical care. Authorities working with migrants in an irregular situation, healthcare providers, civil society actors and migrants themselves are not necessarily aware of rules and entitlements concerning healthcare for migrants in an irregular situation. EU Member States should find ways of addressing the lack of accurate information among migrants, healthcare providers and public authorities such as increasing funding for training, information campaigns and outreach activities in migrant communities, and fostering partnerships between healthcare providers and civil society. Specific objectives To concretise the type of healthcare services which should be provided to irregular migrants To define ways to overcome obstacles preventing access to healthcare for migrants in an irregular situation Participation The meeting brings together representatives of Professional Health Associations, Medical Chambers, EU Member State governments, NGOs, international organisations as well as EU bodies and institutions. Key questions to be addressed at the meeting Which are the healthcare services to be provided to irregular migrants, including from a public health perspective? How does the code of ethics for medical professionals influence access to healthcare for irregular migrants? How should the procedure for reimbursing the healthcare provider be set up? What is the impact on reporting and data exchange practices with other authorities and how can the risk that persons accessing healthcare are reported to the immigration law enforcement authorities be reduced? How should the qualifying conditions for access to healthcare for migrants in an irregular situation look like? How to address the lack of accurate information among migrants, healthcare providers and public authorities? Expected outcomes Suggestions for action at the national and EU level on: Type of healthcare services which should be provided to irregular migrants Measures to be taken to overcome obstacles preventing access to healthcare for migrants in an irregular situation. 3

4 THURSDAY, 1 MARCH 2012 AGENDA 09:00 09:30 REGISTRATION OPENING SESSION Welcome MORTEN KJAERUM, Director, The EU Agency for Fundamental Rights (FRA) 09:30 10:30 Equality of access and quality of care for everybody as a fundamental principle of healthcare systems a doctors perspective KONSTANTY RADZIWILL, President, Standing Committee of European Doctors (CPME) Purpose of the meeting LUDOVICA BANFI, Programme Manager, FRA ANN-CHARLOTTE NYGÅRD, Programme Manager, FRA Tour de table: Participants are invited to share their interests to contribute to the discussions on access to healthcare for irregular migrants 10:30 11:15 WORKING GROUPS: WHICH ARE THE HEALTHCARE SERVICES TO BE PROVIDED TO MIGRANTS IN AN IRREGULAR SITUATION? Introductory presentations REGIS BRILLAT, Head of the Department of the European Social Charter and the European Code of Social Security, Council of Europe ELIS ENVALL, Programme Officer, Swedish National Board of Health and Welfare 11:15 11:30 COFFEE BREAK Framing of the topic: overview of approaches to providing healthcare to irregular migrants Working Group 1: Controversial issues - Providing entitlements to healthcare for migrants in an irregular situation, which are the controversial issues? Working Group 2: Promoting entitlements - For healthcare services generally considered to be provided to irregular migrants, how to promote entitlements? REPORTING BACK FROM THE WORKING GROUPS IN PLENARY Working Group 1: Which are the services to be provided? Working Group 2: How to promote entitlements? Discussion 4

5 LUNCH WORKING GROUPS: OBSTACLES PREVENTING ACCESS TO HEALTHCARE FOR IRREGULAR MIGRANTS Working Group 1: Qualifying conditions for the irregular migrant to access healthcare and reimbursement of healthcare providers Introductory presentation: ALEXANDRE LESIW, Director, Federal SPP Sociale Integration, Belgium Participants will discuss in a working group: - Is there a need to review the qualifying conditions which the irregular migrant has to fulfil? - How should reimbursement procedures be set up and why? Working Group 2: Reporting obligations and data exchange Introductory presentation: ANNA DEUTELMOSER, Legal Adviser, Federal Government Commissioner for Migration, Refugees and Integration, Germany Participants will discuss in a working group: - How can the risk that persons accessing healthcare are reported to the immigration law enforcement authorities be reduced, how should a firewall work? - How do the professional ethics of healthcare staff play in? Working Group 3: Awareness raising and lack of accurate information Introductory presentation: HERVÉ BERTEVAS, Member of the Board, Doctors of the World Participants will discuss in a working group: - How to address the lack of accurate information among migrants, healthcare providers and public authorities? - Which are the actors to be involved? 15: COFFEE BREAK 5

6 REPORTING BACK FROM THE WORKING GROUPS IN PLENARY Working Group 1: Minimum qualifying conditions for accessing health Main characteristics of an efficient reimbursement procedure Working Group 2: Arguments for discouraging data exchange and reporting practices and setting up mechanisms to prevent data exchange and reporting? Working Group 3: How to reach out with accurate information among migrants, healthcare providers and public authorities Discussion WHAT ARE THE LESSONS LEARNED FROM PREVIOUS INITIATIVES TO INFLUENCE POLICY CHANGE? - What are the lessons learned from previous initiatives to influence policy change? Which are the enabling conditions that could help us move the issues? SUMMARY OF THE MEETING Concluding remarks N.B.:English-French translation will be provided at the meeting. 6