“Are migrants half persons?” Health care for undocumented migrants in Belgium: complexity within large discretionary space.
(2016) EUPHA’s 6th European Conference on Migrant and Ethnic Minority Health — Location: Oslo, Norway (23.June.2016)
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- Abstract
- Background: Since 1996, Belgium has a unique procedure granting access to health care for undocumented migrants (UM): the “Urgent Medical Aid” (UMA). This research aimed at assessing the current procedures granting UMA from the perspectives of both health care professionals and UM in order to improve the accessibility and availability of UMA for UM. Methods: In 2015, we conducted a SWOT analysis to identify both challenges and good practices in the application of the UMA. We conducted 33 interviews with UM and 6 focus groups with health care professionals and health care managers in 5 major Belgian cities. Data were analyzed with the framework of De Bie & Roose including 7 dimensions of access to and quality of care, and integrated into a SWOT framework. Results: Complexity of the procedures and discretionary decisions in all stages of the procedure were two of the cross-cutting themes that ware mentioned by both UM and health care professionals. Currently, each local social service has important freedom in how the UMA is organized and delivered, evoking uncertainty in the way access to the procedure is (not) granted and leading to unequal ways of treatment across UM. The specific procedural requirements to grant and carry out UMA also vary from municipality to municipality, complicating the medical practice of health care professionals. Therefore, the availability and accessibility of UMA highly depend on the persons involved in the procedure. Further, some practices clearly contradict the legal frameworks on social support and patient rights, leading to micro-violations of these laws. Standardization of the procedures, developing an independent system of quality control and providing UMA to a household instead of to a single individual were amongst the solutions that participants identified. Discussion: The procedural complexity and the discretionary decisions undermine the UMA’s objectives to grant access to health care to all UM, equally as universal health care to Belgian nationals. Yet, the proposed standardization of procedures requires caution in order to avoid a decrease in the health care package that is currently covered by the UMA. Main messages: Complexity of the procedure and discretionary decisions undermine the humanitarian objectives of the UMA procedure in Belgium. Discretionary decisions lead to law violations, which remain unpunished as long as UM do not report on it.
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Citations
Dauvrin, M., Keygnaert, I., Gysen, J., Kerstens, B., Lorant, V., & Derluyn, I. (2016). “Are migrants half persons?” Health care for undocumented migrants in Belgium: complexity within large discretionary space. EUPHA’s 6th European Conference on Migrant and Ethnic Minority Health, Oslo, Norway. https://hdl.handle.net/2078.5/52026