02/06/2021 – Maastricht Migration Lecture Series: Challenges in using healthcare services by undocumented migrants in Europe: what does the evidence show?

Migration has become an essential topic of social and political debates in Europe. But the migrants’ perspective has seldom been considered in these debates. For instance, are migrants satisfied with their new living environment, and are they given the opportunity to integrate into the hosting community? Can they access essential public services, such as education and healthcare?
It is difficult to give a clear-cut answer to such questions because migrants are not a homogenous group but individuals with diverse backgrounds, preferences, and needs. The migrants’ legal status matters as well. Undocumented migrants without a permit authorizing them to reside in the host country, represent an especially vulnerable group.

Undocumented migrants face particular challenges in using healthcare services in many European countries. Migrants without a proper registration tend to go to clinics for free primary care or directly to hospitals rather than consulting general practitioners. Fear of being deported and the limited entitlements to healthcare are usually the key explanations. In some European countries, undocumented migrants are only provided with access to emergency care or sometimes to services for specific conditions (e.g. infectious diseases) or specific needs (e.g. maternal healthcare).

But even in the case of maternal healthcare, which undocumented migrants are usually entitled to access in Europe, under-utilization and inadequate care are reported. A typical example of this is the late appearance of pregnant undocumented women in clinics. Lack of awareness of entitlements and need of care, or uncertainty and fear of consequences are likely to be contributing factors.

Undocumented migrants are exceptionally vulnerable, not only because they face numerous barriers in utilizing healthcare services, but also because their other basic human needs are not met.

About the speaker

Milena Pavlova is Professor of Health Economics and Equity at Maastricht University. Her research focuses on the healthcare financing, including health insurance, cost-sharing policies, formal and informal out-of-pocket payments, equity and access to care, ability to pay, value-based healthcare. From 2008 to 2013, she coordinated the FP7 project “Assessment of patient payment policies and projection of their efficiency, equity and quality aspects: the case of Central and Eastern Europe”. She has participated in several other EU projects, such as the H2020 TRANS-SENIOR, the CHAFEA Cross-border.Care project, the CHAFEA ProHealth65+ project, and the ERASMUS+ project BIHSENA on capacity building in the Eastern European Neighbouring Areas.
She is active member of the Scientific Committee of the Netherlands Red Cross and also the chair of the ASPHER working group on Economic Evaluation in Healthcare in Europe. She has been assessor for the European Commission on several occasions and reviewer for the International Health Economics Association.
Her publication list includes more than 150 research papers in renowned academic journals and various policy reports, including the report on universal health coverage and financial protection in Poland prepared in cooperation with the WHO Barcelona Office for Health Systems Strengthening.
In 2016, she received the AXA Award for a successful mid-career researcher, and in 2017, she was awarded the title Honorary University Professor by the Corvinus University of Budapest.

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