“Save money, provide free healthcare for the undocumented,” say EU researchers


Significant financial savings could be made if European countries provided unrestricted free healthcare to undocumented migrants, say researchers.

A recent report published by the European Union Agency for Fundamental Rights (FRA) estimated the cost of providing early healthcare to pregnant irregular migrants and those suffering from hypertension in three countries in Europe.

Compared to the cost of receiving emergency care only, researchers found that improved pre-natal care could save up to 48 per cent in Germany and Greece and 69 per cent in Sweden over two years.

For irregular migrants suffering with hypertension, early treatment could potentially prevent more than 300 strokes and 200 heart attacks per 1,000 migrants in each country, according to the report.

“These three countries were chosen because of their different systems, which means the results can be applied to other countries in Europe,” explains FRA spokesperson Blanca Tapia.

Although the exact number of undocumented migrants is unknown, 2009 data suggested that they make up less than one per cent of the overall EU population. However, with more than 750,000 migrants and refugees having arrived in the EU this year alone, the number of irregular migrants is expected to grow.

Tapia hopes the FRA findings will help convince policy makers that providing healthcare to this group is both “economically sound” and “necessary to meet EU member states’ fundamental rights obligations”.

Although the right to access healthcare is enshrined in EU and United Nations human rights charters, national policies can vary widely.

Analysis carried out in 2010 by the Austrian-based Centre for Health and Migration found that 13 countries in the EU restricted undocumented migrants to emergency services only, and in nine other countries even emergency care was inaccessible.

Centre director Ursula Trummer says apart from changes in Spain and Sweden their analysis is still relevant today. Preliminary findings from new research by the Centre for Health and Migration (C-HM), due to be published early next year in partnership with the International Organization for Migration (IOM), also strengthens the economic argument, suggesting that savings of between 50 per cent and 90 per cent could be made by providing primary care.


“Optimistic and hopeful”

This follows a study published in July 2015 by Dr. Oliver Razum at the University of Bielefeld in Germany. He found healthcare expenditures in Germany between 1994 and 2013 were 40 per cent higher for asylum seekers and refugees, who had restricted access, compared to a group with regular access.

“The debates are getting more and more concentrated on the economic arguments,” Trummer tells Equal Times.

Frank Vanbiervliet , the European advocacy coordinator for healthcare NGO Médecins du Monde (MdM) says that he is “optimistic and hopeful” that stronger economic arguments will help influence EU policy, although he warns it will not be enough by itself.

“The problem is that health policies are too often integrated with immigration policies,” he says.

Some policy makers argue that an open health system attracts more migrants, reducing cost-effectiveness. In the UK this argument led to a “health surcharge” for non-EU migrants, introduced as part of reforms to the 2014 Immigration Act “focused on stopping illegal migrants using public services to which they are not entitled”.

But being unregistered, undocumented migrants do not pay the surcharge; instead they have to pay for many NHS services upfront, which can be very difficult for a group typically in low-paid work.

Data collected by MdM, however, shows that the vast majority of undocumented migrants say they migrated due to economic reasons or war and persecution, with only 3 per cent citing healthcare reasons. Those who do use MdM’s services have on average lived in the host country for 6.5 years before seeking treatment.

When they do seek healthcare, the issues are often related to living and working conditions, where undocumented migrants are at risk of exploitation.

Dr. Carina Spak is the director of Amber Med, a Vienna-based clinic for uninsured people – mostly from migrant communities – run by local social welfare NGO Diakonie. “We often see the “poor” health problems – diabetes, blood pressure, back pain – which are related to the conditions people live in,” she explains.

Amber Med receives some financial support from the local health insurance agency that recognises the benefit of universal early treatment. In other regions, such as northern Italy and southern Spain, local authorities have received praise for taking similar steps to secure broad access for undocumented migrants, even if national policy supports a more restrictive approach.

“There is much variation from within countries at a regional level,” explains Trummer. “But political atmosphere is of course always important. You have to have political will to make it work.”