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Cura della salute e sistemi sanitari: il caso dei migranti in Europa
Titolo Rivista: MONDI MIGRANTI 
Autori/Curatori: Caterina Francesca Guidi 
Anno di pubblicazione:  2019 Fascicolo: Lingua: Italiano 
Numero pagine:  17 P. 191-207 Dimensione file:  207 KB
DOI:  10.3280/MM2019-002010
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Una delle sfide più avvincenti della globalizzazione consiste nell’adeguamento dei sistemi di welfare, in particolar modo di quelli sanitari, alle richieste che la migra-zione e la mobilità impongono. L’Unione Europea (UE) presenta tra i propri Stati Membri (SM) situazioni fortemente differenziate in termini di modelli sanitari, di sistemi di contribuzione fiscale e di politiche d’integrazione dei cittadini stranieri. Rispetto ad altri paesi a più lunga tradizione migratoria, nell’UE notevoli sono an-cora le differenze nell’accesso e nell’utilizzo dei sistemi sanitari da parte di migran-ti intra-UE e migranti provenienti da paesi terzi, e ulteriormente diversificati in base allo status giuridico di quest’ultimi. Parallelamente, alla storica ipotesi dell’effetto migrante sano - che afferma che i migranti hanno un miglior stato di salute rispetto ai nativi o le seconde generazioni nel paese di destinazione, si sta sostituendo l’effetto migrante esausto. Meccanismi concomitanti - quali la povertà, la discriminazione sofferta nel mercato del lavoro, il viaggio intrapreso e le condizioni di vita offerte dai paesi di accoglienza o il ritardo e l’esclusione dai diritti civili e politici - possono influenzare le opportunità dei migranti in termini dell'assistenza sanitaria ricevuta e di malattie sofferte, condizionando il deterioramento della loro sta-to di salute nel corso del tempo e in ogni fase del progetto migratorio. Basti guardare alla relazione tra il Migrant Integration Policy Index (Mipex) realizzato dal Migrant Policy Group nel 2015 e quella estratta dall’Eurobarometro del 2014: sull’asse delle ordinate vengono riportate le valutazioni delle politiche sanitarie a sostegno o meno dei migranti negli SM dell’UE, mentre su quelle dell’ascisse la percentuale di persone che negli stessi alla domanda "Come valuti la qualità complessiva del tuo sistema sanitario?" ha risposto "buona". Com’è evidente, emergono dei cluster di paesi di cui cercheremo di analizzare le peculiarità economico-finanziarie dei sistemi sanitari nell’adeguamento alle nuove domande di salute dei cittadini migranti, riportando l’evidenza empirica relativa ad alcuni casi studio (in particolare Germania, Italia, Regno Unito e Spagna). Scopo più specifico di questo contributo, partendo dalle tradizionali tipologie di sistemi sanitari, è stabilire una relazione con i costi e le performance di risposta alla domanda di assistenza di origine migratoria. In economia sanitaria, sta diventando ogni giorno più evidente che la salute dei migranti rappresenta una grande sfida. La salute pone un serio problema di disuguaglianza e di esclusione sociale nelle società di destinazione: comprendere le variabili, fondatrici e co-fondatrici, è un esercizio fondamentale per studiare le determinanti di accesso, uso e la qualità dei servizi sanitari. La difesa della sostenibilità dei sistemi sanitari dal lato del finanziamento è un prerequisito perché questa grande sfida sia affrontata e vinta in Europa.


Keywords: Salute, migrazione, misurabilità, evidence-based, politiche sanitarie.

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Caterina Francesca Guidi, in "MONDI MIGRANTI" 2/2019, pp. 191-207, DOI:10.3280/MM2019-002010

   

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