Healthcare for undocumented migrants in Italy : policy inclusiveness and exclusionary claims

Roberta Perna, political sociologist

The Italian healthcare system is quite inclusive towards undocumented migrants. Yet, exclusionary discourses have emerged over time, grounded on the costs of such inclusiveness. Data – although scarce – provide a different picture.

Introduction

One of the EU coun­tries with the largest esti­mates about the presence of undo­cu­mented migrants (UMs) and with a univer­sa­listic health system (Sistema Sani­tario Nazio­nale – SSN), Italy guaran­tees exten­sive heal­th­care to UMs. However, and despite what data says, welfare chau­vi­nist discourses have fuelled in the country, depic­ting UMs as a burden for the SSN.

Policy rules

In its Preamble, the 1998 Immi­gra­tion Law affirms the duty of guaran­teeing funda­mental human rights to forei­gners, regard­less of their legal status.^[1]Heal­th­care is the sole right expli­citly defined as funda­mental in the Italian Consti­tu­tion. Then, its Health Section stipu­lates that UMs shall have access to “urgent and essen­tial care” on a conti­nuous basis, inclu­ding pregnancy and mater­nity care, child­care, and public health measures.^[2]Urgent care refers to services that cannot be deferred without putting the person’s life and health at risk. Essen­tial care includes diag­nostic and thera­peutic services related to non-dange­rous patho­lo­gies in the short term, but that could cause greater damage to the person’s health over time (eg, compli­ca­tions, chronic … Lire la suite In proce­dural terms, heal­th­care access is provided via an anony­mous code, which is valid for 6 months and can be renewed. Impor­tantly, health workers cannot report UMs to the police.

For what concerns provi­sion, each region shall iden­tify the most appro­priate ways to guarantee heal­th­care access to UMs in its terri­tory, reflec­ting the decen­tra­lised nature of the SSN. Conse­quently, great hete­ro­ge­neity exists across the national terri­tory.^[3]For instance, some regions provide primary care to UMs via dedi­cated public clinics, others through mains­tream general prac­ti­tio­ners, while still others through accre­dited non-govern­mental orga­ni­sa­tions. Diffe­rences also exist in terms of provi­sions that regions may decide to further put in place : eg, 12 regions over 20 extended … Lire la suite

« As research demonstrates, restricting healthcare access for UMs is inefficient and irrational, even when endorsing pure economic or public health views only. Unfortunately, politics often blind individuals. »

Roberta Perna, poli­tical sociologist

Finally, in terms of finan­cing, treat­ments provided to UMs shall be reim­bursed to regions by the central govern­ment, while the orga­ni­sa­tion of heal­th­care (inclu­ding, eg, media­tion services, medical staff and mate­rial resources for primary care) lies on each region’s budget. Migrants should parti­ci­pate in the costs of treat­ments received but, as in the case of Italian citi­zens, they may be exempted from co-payments for health reasons (eg, chronic disease, severe patho­logy) or economic reasons (economic indigence).

A welfare burden ? Exclusionary claims vs. (few) data 

Heal­th­care access for UMs has often been framed as a “welfare burden” by Italian right-wing, anti-immi­gra­tion parties, such us the League and Fratelli d’Italia. Parti­cu­larly at times of economic crises, they have frequently mobi­lised the (alleged) high cost of provi­ding heal­th­care to unde­ser­ving “clan­des­tini” and “frau­dulent medical tourists” against the shor­tages suffered by the “Italian poor”, calling for their exclu­sion from free-of-charge healthcare.

These discourses – char­ging with racial shades the impe­ra­tives of “ratio­na­li­sa­tion in heal­th­care” and of stop­ping “abuses of the system” that have been present in Italy since the mid-2000s – are contra­dicted by exis­ting data, although limited. For the period 1998–2017, approxi­ma­tely 0.2 % of the annual National Health Fund was allo­cated by the Health Ministry to regions to this end.^[4] Except for emer­gency care, which was reim­bursed by the Home Ministry (no data avai­lable). Since 2018, the dedi­cated line of budget has been merged with other expen­di­ture items, making it impos­sible to retrieve the annual amount of reim­bur­se­ment. For what concerns the costs of treat­ments, in 2010 UMs accounted for 0.4 % of all hospi­ta­li­sa­tions in the country and for 0.34 % of public expen­di­ture for hospi­ta­li­sa­tion.^[5]Agenas, 2013. La valu­ta­zione econo­mica dell’assistenza sani­taria erogata agli immi­grati : meto­do­logia e primi risul­tati. Avai­lable on line [in Italian only]: … Lire la suite

Yet, exclu­sio­nary argu­ments persist, inclu­ding during the COVID-19 pandemic. Next to portraying migrants landing to Italy as vectors of the virus, the League and Fratelli d’Italia harshly criti­cised the regu­la­ri­sa­tion of UMs approved in May 2020 for public health (and economic) reasons, calling the govern­ment to dedi­cate its limited resources to protect the Italians instead.

As research demonstrates[lien vers Vignier], restric­ting heal­th­care access for UMs is inef­fi­cient and irra­tional, even when endor­sing pure economic or public health views only. Unfor­tu­na­tely, poli­tics often blind individuals.