Healthcare and health systems: the case of migrants in Europe

Journal title MONDI MIGRANTI
Author/s Caterina Francesca Guidi
Publishing Year 2019 Issue 2019/2 Language Italian
Pages 17 P. 191-207 File size 207 KB
DOI 10.3280/MM2019-002010
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In these globalization times, one of the most compelling challenges is the adaptation of welfare systems, especially health systems, to the requests that migration and mobility impose. The European Union (EU) presents in its Member States (MS) highly differentiated situations in terms of healthcare systems, models, financing systems and policies of integration adopted towards foreign citizens. Compared to other countries with a longer migrant tradition, there are still significant differences in access and use of health services by intra-EU migrants and migrants from third countries in the EU, further diversified according to the legal status of the latter. In parallel, the historical hypothesis of the healthy migrant effect - which states that migrants have a better state of health than natives and second generation in their countries of destination, has been replacing by the exhausted migrant effect. Concurrent mechanisms - such as poverty, discrimination suffered in the labor market, the journey undertaken and the living conditions offered by the host countries or the delay and exclusion from civil and political rights - can influence the opportunities of migrants in terms of healthcare received and diseases suffered, influencing the deterioration of their state of health over time and at every stage of the migration project. Looking at the relationship between the Migrant In-tegration Policy Index (Mipex) carried out by the Migrant Policy Group in 2015 and the values extracted from Eurobarometer (2014): on the vertical axis, the health policies in support of migrants in the EU MS are reported while the percent-ages of people who replied "Good" to the question: "How do you evaluate the overall quality of your healthcare system?" are on the horizontal axis. As it can be seen, clusters of countries emerge: from those we will try to analyze the economic-financial peculiarities of health systems to the adaptation to new health needs of migrant citizens, reporting the empirical evidence related to some case studies (in particular, Germany, Italy, United Kingdom and Spain). Starting from the traditional types of health systems, a more specific aim of this contribution is to estab-lish a relationship with the costs and performance of the response to the assistance request of migratory origin. In health economics, it is becoming more and more evident that the health of migrants is a major challenge. Health poses a serious problem of inequality and social exclusion in destination societies: understanding the variables, founders and co-founders, is a fundamental exercise to study the determinants of access, use and quality of health services for migrants. The de-fense of the sustainability of health systems on the funding side is a prerequisite for this great challenge to be tackled and won in Europe.

Keywords: Reproductive health, gender-based violence, migration, Vtp, Lampedusa, Sicily

  1. Abraído-Lanza A.F., Dohrenwend B.P., Ng-Mak D.S., Turner J.B. (2005). The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses. American Journal of Public Health, 89, 10: 1543-1548.
  2. Acevedo-Garcia D. e Bates L.M. (2007). Latino health paradoxes: empirical evidence, explanations, future research, and implications. In: Rodriguez H., Saenz R. e Menjivar C., eds. Latino/as in the United States: Changing the face of America (pp. 101-113). New York: Springer.
  3. Acevedo-Garcia D., Bates L.M., Osypuk T.L. e McArdle N. (2010). The effect of immigrant generation and duration on self-rated health among US adults 2003-2007. Social Science & Medicine, 71, 6: 1161-72.
  4. André S., Dronkers J. e Fleischmann F. (2010). Perceptions of In-group Discrimination by First and Second Generation Immigrants from Different Countries of Origin in EU Member States. Florence, Italy: European University Institute.
  5. Antecol H. e Bedard K. (2006). Unhealthy assimilation: why do immigrants converge to American health status levels?. Demography, 43, 2: 337-360.
  6. Asada Y., Hurley J., Norheim O.F. e Johri M. (2015). Unexplained health inequality - is it unfair?. International Journal for Equity in Health, 14, 11: 1-12;
  7. Bambra C. (2005). Worlds of welfare and the health care discrepancy. Social Policy & Society, 4, 1: 31-41.
  8. Bambra C. (2006). Health status and the worlds of welfare. Social Policy and Society, 5: 53-62.
  9. Blom N., Huijts T. e Kraaykamp G. (2016). Ethnic health inequalities in Europe. The moderating and amplifying role of healthcare system characteristics. Social Science & Medicine, 158: 43-51;
  10. Boeri T. e Brücker H. (2005). Why are Europeans so Tough on Migrants?. Economic Policy, 44: 629-704.
  11. Borges D. e Guidi C.F. (2018). Rights of access to healthcare for undocumented migrants: understanding the Italian and British national health systems. International Journal of Human Rights in Healthcare.
  12. Borrell C., Palència L., Bartoll X., Ikram U. e Malmusi D. (2015). Perceived discrimination and health among immigrants in Europe according to national integration policies. International Journal of Environmental Research and Public Health, 12: 10687-99.
  13. Caselli G., Loi S. e Strozza S. (2017). Migration, Health and Mortality in Italy: An Unfinished Story. In: Trovato F., a cura di. Migration, Health and Survival: International Perspectives. Edward Elgar Publishing.
  14. Commission on Social Determinants of Health (Csdh) (2008). Closing the gap in a generation: Health equity through action on the social determinants of health - Final Report. Ginevra: Organizzazione Mondiale della Salute (Oms).
  15. Cookson R., Propper C., Aria M. e Raine R. (2016). Socioeconomic inequalities in health care in England. CHE Research Paper 129. York: University of York.
  16. Cuadra C.B., Björngren C. e Cattacin S. (2011). Policies on Health Care for Undocumented Migrants in EU27: Towards a Comparative Framework. Nowhereland Project-2010. Sweden: Malmö.
  17. Davies A, Basten A. e Frattini C. (2010). Migration: a social determinant of migrants’ health. Migrant Health in the eu, 16: 10-2.
  18. Devillanova C. e Frattini T. (2016). Inequities in immigrants’ access to health care services: disentangling potential barriers. International Journal of Manpower, 37, 7.
  19. Domnich A., Panatto D., Gasparini R. e Amicizia D. (2012). The “healthy immigrant” effect does it exist in Europe today?. Italian Journal of Public Health, 9, 3: 1-7.
  20. Esping-Andersen G. (1990). The three worlds of welfare capitalism. Princeton, New Jersey: Princeton University Press.
  21. Essink-Bot M.L., Lamkaddem M., Jellema P., Nielsen S.S. e Stronks K. (2012). Interpreting ethnic inequalities in healthcare consumption: a conceptual framework for research. European Journal of Public Health, 23, 6: 922-926.
  22. European Commission (ec) (2008). Quality in and equality of access to healthcare services. Brussels, Belgium: European Commission,
  23. European Parliament Research Service (Eprs) (2016). The public health dimension of the European migrant crisis. Briefing, January 2016.
  24. Ferrera M. (1996). The 'Southern model' of welfare in social Europe. Journal of European Social Policy, 6: 17-37.
  25. Forster T., Kentikenelis A. e Bambra C. (2018). Health inequalities in Europe: Setting the State for Progressive Policy Actions. Foundation for European Progressive Studies (Feps), Dublin, Ireland: Tass.
  26. Franzini L. e Giannoni M. (2010). Determinants of health disparities between Italian regions. Bmc Public Health, 10: 296.
  27. Galos E., Bartolini L., Cook H. e Grant N. (2017). Migrant Vulnerability to Human Trafficking and Exploitation: Evidence from the Central and Eastern Mediterranean Migration Routes. Geneva: International Organization for Migration (Iom).
  28. Giannoni M., Franzini L. e Masiero G. (2016). Migrant integration policies and health inequalities in Europe. BMC Public Health, 16: 463.
  29. Gimeno-Feliu L.A., Calderón-Larrañaga A., Diaz E., Poblador-Plou B., Macipe-Costa R. e Prados-Torres A. (2016). Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay. BMC Public Health, 16: 450.
  30. Giuntella O. (2013). Why does the health of immigrants deteriorate? Evidence from birth records. Iza Discussion Paper No. 7588. Bonn, Germany.
  31. Giuntella O. e Mazzonna F. (2015). Do immigrants improve the health of natives?. Journal of Health Economics, 43: 140-153.
  32. Giuntella O., Nicodemo C. e Vargas Silva C. (2015). The Effects of Immigration on Nhs Waiting Times. University of Oxford Working Paper.
  33. Giuntella O., Nicodemo C. e Vargas Silva C. (2016). The impact of immigration on health and health care: Evidence from the United Kingdom. In: Fasani F., a cura di. Refugees and Economic Migrants: Facts, policies and challenges. Cepr Press: Book, Cepr Press.
  34. Giuntella O. e Stella L. (2016). The Acceleration of Immigrant Unhealthy Assimilation. Iza Discussion Paper No. 9664.
  35. Global Compact for Migration (2018). Global Compact for Refugees. Zero Draft, January 2018. New York, Geneva.
  36. Global Compact for Migration (2018). Global Compact for Safe, Orderly and Regular Migration. Final Draft, 11 July. New York, Geneva.
  37. Guidi C.F., Palencia L., Ferrini S. e Malmusi D. (2016). Inequalities by immigrant status in unmet needs for healthcare in Europe: the role of origin, nationality and economic resources. Eui Working Paper RSCAS 2016/55. Florence, Italy: European University Institute.
  38. Guidi C.F. e Petretto A. (2017). Cura della salute ed immigrazione: un’analisi comparata sotto il profilo economico-finanziario. Aic Rivista, 4/2017.
  39. Hadjar A. e Backes S. (2013). Migration Background and Subjective Well-Being: A Multilevel Analysis Based on the European Social Survey. Comparative Sociology, 12: 645-676.
  40. Hilfinger M., Morris McEwen M. e Clark L. (2015). The impact and implications of undocumented immigration on individual and collective health in the United States. Nursing Outlook, 63, 1: 86-94.
  41. Ikram U.Z., Snijder M.B., Fassaert T.J.L., Schene A.H., Kunst A.E. e Stronks K. (2015). The contribution of perceived ethnic discrimination to the prevalence of depression. European Journal of Public Health, 25: 243-248.
  42. Ingleby D., Krasnik A., Lorant V. e Razum O. (2012). Health Inequalities and Risk Factors among Migrants and Ethnic Minorities. Belgium: Maku.
  43. International Organization for Migration (Iom) (2017). Health of migrants: resetting the agenda – Report of the 2nd Global Consultation. Colombo, Sri Lanka.
  44. Isakjee A. (2017). Welfare state regimes: a literature review. Iris Working Paper Series No. 18/2017. Birmingham: University of Birmingham.
  45. Kawachi K.D., Daniels N. e Robinson D.E. (2005). Health Disparities by Race and Class: why both matter. Health Affairs, 24, 2: 343-352.
  46. Kunst A.E., Groenhof F. e Mackenbach J.P. (1998). Occupational class and cause specific mortality in middle aged men in 11 European countries: comparison of population-based studies. British Medical Journey, 316: 1636-1642.
  47. Lancet (2018). No public health without migrant health. Editorial, Lancet, 3, 6: e259.
  48. Levecque K. e Van Rossem R. (2015). Depression in Europe: Does migrant integration have mental health payoffs? A cross-national comparison of 20 European countries. Ethnic Health, 20: 49-65.
  49. Lindert J., von Ehrenstein O.S., Priebe S., Mielck A. e Brahler E. (2009). Depression and anxiety in labor migrants and refugees – A systematic review and meta-analysis. Social Science & Medicine, 69: 246-257.
  50. Mackenbach J.P. (2006). Health inequalities: Europe in profile. United Kingdom: Department of Health.
  51. Mackenbach J.P. (2012). The persistence of health inequalities in modern welfare states: the explanation of a paradox. Social Science & Medicine, 75, 4: 761-769.
  52. Mackenbach J.P., Meerding W.J. e Kunst A.E. (2011). Economic Costs of Health Inequalities in the European Union. Journal of Epidemiology & Community Health, 65, 5: 412-419.
  53. Malmusi D. (2014). Immigrants´ health and health inequality by type of integration policies in European countries. European Journal of Public Health, 25, 2: 293- 299.
  54. Malmusi D., Borrell C. e Benach J. (2010). Migration-related health inequalities: showing the complex interactions between gender, social class and place of origin. Social Science & Medicine, 71, 9: 1610-1619.
  55. Marmot M.G. (2005). Social determinants of health inequalities. Lancet, 372: 1661-1669.
  56. Marmot M.G., Allen J., Bell R., Bloomer E. e Goldblatt P. (2012). “who European review of social determinants of health and the health divide. Lancet, 380, 15: 1011-1029.
  57. Marmot Review (2010). Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England Post 2010. London: Marmot Review.
  58. Meuleman B. e Reeskens T. (2008). The relation between integration policy and majority attitudes toward immigration. An empirical test across European countries. Leuven Paper presented at the Dag van de Sociologie.
  59. Mladovsky P. (2011). Migrant health policies in Europe. In: Rechel B., Mladovsky P., Devillé W., Rijks B., Petrova-Benedict R. e McKee M., eds. Migration and health in the European Union (pp.185-201). Maidenhead: Open Univ. Press.
  60. Moullan Y. e Jusot F. (2014). Why is healthy migrant effect different between European countries?. European Journal of Public Health, 24, 1: 80-86.
  61. Orrenius P.M. e Zavodny M. (2012). Immigrants in risky occupations. Iza Discussion Paper 6693. Bonn, Germany.
  62. Palència, L., Malmusi, D., De Moortel, D., Artazcoz, L., Backhans, M., Vanroelen, C., Borrell e C., 2014. The influence of gender equality policies on gender inequalities in health in Europe. Social Science & Medicine, 117: 25-33.
  63. Potarca G. e Bernardi L. (2018). The (Un)Healthy Migrant Effect. The Role of Legal Status and Naturalization Timing (chapter 6). In: Tillmann R. et al., eds. Social Dynamics in Swiss Society, Life Course, Research and Social Policies, 9.
  64. Preston I. (2014). The effect of migration on public finances. The Economic Journal, 124: 569-592.
  65. Razum O. (2006). Commentary: Of Salmon and Time Travellers - Musing on the Mystery of Migration Mortality. International Journal of Epidemiology, 34: 919-921.
  66. Razum O. e Twardella D. (2002). Time travel with Oliver Twist - towards an explanation for a paradoxically low mortality among recent immigrants. Tropical Medicine and International Health, 7:4-10.
  67. Razum O., Zeeb H. e Rohrmann S. (2000). The Healthy Migrant Effect -Not Merely a Fallacy of Inaccurate Denominator Figures. International Journal of Epidemiology, 29: 191-192.
  68. Rechel B., Mladovsky P., Devillé W., Rijks B., Petrova-Benedict R. e McKee M. eds. (2011). Migration and health in the European Union.Mainhead: Oup.
  69. Rechel B., Mladovsky P., Ingleby D., Mackenbach J.P., McKee M. (2013). Migration and health in an increasingly diverse Europe, Lancet, 381: 1235-1245.
  70. Sander M. (2007). Return Migration and the "Healthy Immigrant Effect. Soep papers on Multidisciplinary Panel Data Research N. 60.
  71. Solar O. e Irwin A. (2010). A conceptual framework for action on the social determinants of health - Social Determinants of Health. Discussion Paper 2 (Policy and Practice). Ginevra: Organizzazione Mondiale della Salute.
  72. Solé-Auró A., Guillén M. e Crimmins E.M. (2012). Health care usage among immigrants and native-born elderly populations in eleven European countries: results from share. European Journal of Health Economics, 13, 6: 741-754.
  73. Spinakis A., Anastasiou G., Panousis V., Spiliopoulos K., Palaiologou S. e Yfantopoulos J. (2011). Expert review and proposals for measurement of health inequalities in the European Union - Full Report. Luxembourg: European Commission Directorate General for Health and Consumers.
  74. Steventon A. e Bardsley M. (2011). Use of secondary care in England by international immigrants. Journal of Health Services Research & Policy, 16, 2: 90-94.
  75. Suhrcke M., Sauto Arce R., McKee M. e Rocco L. (2008). The Economic Costs of Ill Health in the European Region. Copenaghen, Denmark: Organizzazione Mondiale della Salute – Ufficio Regionale per l’Europa.
  76. Thomson S., Foubister T. e Mossialos E. (2009). Financing Health Care in the European Union. Copenhagen: Who Regional Office for Europe.
  77. United Nations (2015). Sustainable Development Goals. New York, Geneva.
  78. Wadsworth J. (2013). Mustn’t Grumble: Immigration, Health and Health Service Use in the UK and Germany. Fiscal Studies, 34, 1: 55-82.
  79. Wadsworth J., Dhingra S., Ottaviano G. e Van Reenen J. (2016). Brexit and the impact of immigration on the uk. Centre for Economic Performance Paper Brexit 05. London, uk: London School of Economics.
  80. Whitehead M. (1990). The concepts and principles of equity and health. Copenhagen, Denmark: Oms – Ufficio Regionale per l’Europa.
  81. Whitehead M. e Dahlgren G. (2006). Concepts and principles for tackling social inequities in health: Levelling up, part 1. Copenhagen, Denmark: Oms - Organizzazione Mondiale della Salute – Ufficio Regionale per l’Europa.
  82. Wickramage K., Vearey J., Zwi A.B., Robinson C. e Knipper M. (2018). Migration and health: a global public health research priority. Bcm Public Health, 18, 987: 1-9.
  83. World Health Organization (who) Regional Office for Europe (2016). Strategy and action plan for refugee and migrant health in the who European Region. Working Document. Copenhagen, Denmark.
  84. World Health Organization (who) (2010). Health of migrants: the way forward - report of a global consultation. Madrid, Spain.

Caterina Francesca Guidi, Cura della salute e sistemi sanitari: il caso dei migranti in Europa in "MONDI MIGRANTI" 2/2019, pp 191-207, DOI: 10.3280/MM2019-002010