Restricted Health Care Entitlements for Children Migrants in Europe and Australia
Type of text: Academic article
Published by: The European Journal of Public Health
Author: Liv Stubbe Ostergaard, Marie Norredam, Claire Mock Munoz de Luna, Mitch Blair, Sharon Goldfeld & Anders Hjern
Available at: https://academic.oup.com/eurpub/article/27/5/869/3867788
Short description of text
The study aims to compare national legal entitlements to health care for children who are asylum seekers or have an irregular migrant status, (including EU nationals who have made use of the right to free movement within the EU, but cannot make use of the directive on cross border-health care) with those of resident children in Europe and Australia using the framework of the United Nations Convention of the Rights of the Child.
Most important results
– In France, Italy, Norway, Portugal and Spain all categories of migrant children regardless of legal status are granted equal entitlements and included in the same health care system as national children.
– Sweden and Belgium offer equal entitlements to asylum seeking children and children of irregular third-country migrants, however, entitlements for children of irregular EU-nationals are unclear.
– 19 European countries include asylum seeking children equally in health care services offered to national children and in the same healthcare system.
– For children with irregular migrant status and originate outside of EU/EEA, only seven countries provide equal entitlements.
– In 15 countries, children with irregular migrant status are only entitled to emergency care free of charge. In most of these countries no specific health care provisions for children in an irregular situation exist, and it is therefore assumed they are entitled only to minimum care.
– Germany stands out as the country with the most restrictive policy. ‘In Germany irregular migrants must go through the social welfare office in order to receive health care. Since this office has a duty to report irregular children to the authorities, in effect this limits children’s access to health care’ (p. 871)
– In Finland some municipalities have decided to provide all health care services for irregular children and pregnant women.
– ‘Entitlements for children of irregular migrants that originate within the EU are unclear in many countries … These children are in a legal vacuum despite having EU citizenship … They also fall outside EU social security regulations and regulations applicable to irregular migrants originating outside of EU’ (p. 871).
– In 12 countries, UAMs have broader entitlements to health care than accompanied migrant children.
– ‘No more than a handful of EU/EEA member states have a policy that provides equal entitlement of care to children in the host population for all migrant children. This is an obvious breech of the non-discrimination principle in article 2 of the UN Convention on the Rights of the Child, signed by all countries included in the study. ‘Asylum seeker’ is the legal category of children most often entitled to health care on equal terms with resident children. Nineteen out of 31 states have such entitlements, while only 7 nations have such entitlements for irregular or undocumented children from non-EU/EEA countries (p. 871).
– ‘A number of countries use concepts such ‘basic’, ‘necessary’ or ‘emergency’ care to define the entitlements to care for migrants. These vaguely defined entitlements make decisions on access to health care arbitrary and dependent on the judgement of individual health care providers, and often leads to the exclusion from access to primary care’ (p. 871).
– ‘The way health care is funded differs considerably across the EU/ EEA and Australia. Some countries have a tax-based system while others are funded insurance schemes. Although it is often more administratively complicated to fund health care for migrant children in insurance-based systems, we found no obvious relationship between the funding system and health care policy for migrant children’ (p. 871).
– ‘25 out of the 31 countries appear to be failing the children’s rights to which they claim allegiance (p. 872).
Quantitative. Data derived from an open ended questionnaire prepared for the European project ‘Models of Child Health Appraised’ (MOCHA), where one focus is on equitable health care for all children. It surveyed national legal entitlements to health care for three categories of migrant children (0-17 years); asylum seekers, children with an irregular migrant status and UAM. It was distributed to 31 European national Country Agents and Australia (MOCHA participants), all experienced child health professionals familiar with their national settings. It was also distributed to 31 national Human Rights Institutes and NGOs and 25 members of the European Network of Ombudspersons for Children (ENOC). Supplementary data from governments in Europe and Australia and reports from NGOs and the European Union were included to coherence test the responses and provide additional information on the countries.
‘Health care provided in a primary care setting is in most societies the most cost–effective way of providing psychological care for migrant children, and thus a way to fulfil the rights of rehabilitation for victimised children as expressed in paragraph 39 of the UNCRC. It also has the potential to meet their accumulated health care needs, for early detection of communicable disorders and the provision of preventive interventions such as vaccinations and screenings for malformations and disabilities’ (p. 871).
‘Fear of police or immigration authorities is a major barrier for irregular migrants to access the care to which they are entitled. Thus, to make health care truly accessible for irregular migrants, health services should be entirely independent from immigration authorities, and the principles of medical confidentiality should be upheld for these patients. In this sense, the policy in Germany and Bulgaria of a legal duty for health services to report irregular migrants stand out as the most obvious negative policy example’ (p. 871).