Should Migrants & Refugees be Entitled to Healthcare?

Introduction

Migrants and refugees are some of the few who go through one of the largest epidemics of lack of healthcare access and coverage. Healthcare allows for coverage of medical services and in most cases coverage for prescription drugs. However, with refugees and migrants living in a different country besides their native country, they are most likely not provided healthcare. This lack of access causes increased susceptibility to disease and infections that migrants and refugees have never been exposed to, that disable treatment of severe illnesses.

 Migrants and refugees worldwide should be entitled to have access to one of the most basic human necessities — healthcare. Universal health care or the creation of an individualized health system for migrants and refugees may be a solution to help divert this lack of healthcare access.

Overview

In today’s world, approximately one percent of the world’s population  (7.7 billion) is made up of refugees and migrants. According to Figure 1, there is an approximate total of 68.5 million people who were displaced worldwide, 40 million being forcibly displaced, 25.4 million being refugees, “half of which are children under the age of 18” (Gale Group), and 3.1 million being seekers of asylum. According to Paul Caulford’s and Yasmin Vali’s article, “Providing Health Care to Medically Uninsured Immigrants and Refugees,” many refugees are “not granted public health insurance in countries that receive them and cannot afford to pay for health care expenses out of pocket”. Many refugees are “…unemployed, live in deprived neighborhoods, and have an increased risk of ethnic and social vulnerability that influences their health negatively” (Sundquist). They are also at a greater risk for an array of health issues due to unsafe travel through unsanitary and poorly resourced settings, which causes exposure to “physical and psychological dangers” (Matsumoto et al.), as well as infectious disease. Besides the increased risk for disease and infections, there is a “rising concern that migrants’ health needs are not always adequately met” (World Health Organization), which should be a concern. Migrants and refugees face many challenges in accessing healthcare due to their “legal status, language barriers, and discrimination” (World Health Organization). The World Health Organization, however, appeals to all countries to “… implement policies that provide health care services to all migrants and refugees, irrespective of their legal status”.

Although most hosting countries extend a principle of some kind of medical screening upon arrival, “… many refugees do not benefit from these services and the quality of the screening programs is questionable…” (Langlois), there are also many legal restrictions that impede on refugees’ access to health care. Access to healthcare is also impeded due to migrants and refugees being “… unfortunately excluded from most national health systems designed to address the needs of citizens” (Abubakar and Alimmudin). This demonstrates that the “poor access to health-care services interacts with discrimination and limited social rights thereby reinforcing exclusions as a root cause of ill health among refugees” (Langlois), as well as restrictions with “great variation in entitlements” (Langlois).  There are also many practical barriers that hinder access for health services such as “inadequate information and awareness about the availability of services, insufficient financial means, restricted access to transport, culturally insensitive care, and inadequate provisions of interpreters” (Langlois).

 Universal health coverage (UHC) was first recognized in 2010 by the United Nations and is a commitment of all-inclusive coverage, requiring that “all people have access to health services — including prevention, treatment, rehabilitation, and palliative care — without risk of financial hardship” (Abbas et al.), however does not apply to migrants and refugees. The impact of UHC on migrants’ health could be more positive, if UHC was “embedded into a broader perspective of universal social rights coverage” (Abbas).

 In the World Health Organization’s article, “Overcoming Migrants’ Barriers to Health”, Dr. Daniel López-Acuña statedthat it is “essential to train policy-makers and health stakeholders on migrant health issues, and to improve service delivery to reinforce migrant-friendly public-health services and establish minimum health-care standards for all vulnerable migrant group”. Ideal health systems would provide for

 “… quality and affordable health coverage as well as social protection for all refugees and migrants regardless their of legal status; making health systems culturally and linguistically sensitive to address the communication barrier; ensuring health care

workers are well-equipped and experienced to diagnose and manage common infections

and diseases…” (World Health Organization),

 and improved collection of data on refugee and migrant help.

Possible Solutions

There are many plausible solutions that would allow migrants and refugees to have access to healthcare. One solution involves for a healthcare system to be developed, to temporarily allow migrants and refugees access to healthcare for an allotted period of time. During the start of the change, as migrants and refugees are entering the country, they will be evaluated by doctors who would then prescribe the necessary treatments and treatment time needed for each patient. This will then help delegate the time span of health care they will have before they are charged at an affordable rate. The migrants and refugees will be evaluated each year by doctors, as well as have their financial statements reviewed to help determine if aid is still needed. According to the aritcle “Refugees: towards Better Access to Health-Care Services,” by Etienne V. Langlois, “greater efforts are needed to strengthen the resilience of  [the] health system to foster equality and efficiency in refugee health.” There will be an ubiquitous legislation stating the country that is hosting the migrants will pay for and provide them with healthcare until they are financially stable enough to pay for the affordable care.  In order to prevent abuse of access to healthcare, each migrant and refugee will be provided a designated health care card that tracks each visit as well as provide detailed documentation about the visit. The card will provide a limit (determined by a doctor) of up to five visits or less a month depending on the severity of the case. Another possible solution would be a tax bill that requires the financially stable countries to pay a tax based on their population which will then be used towards healthcare to help make it more affordable or create a universal healthcare system that benefits all.

The possible benefits of these solutions are that all migrants and refugees who may have never had access to healthcare before will have access as well as aid for their medical needs.

Other benefits are that the rate of disease or infections within the population will decrease due to inadequate living conditions including poor sanitation and contamination. Along with the decrease of disease or infections within the displaced population, there will be a decrease in disease or infection within the native population of the host country. Migrants and refugees may have left countries where endemic diseases such as tuberculosis can be found, exposing natives. This, however, can be treated provided access to healthcare.  Health is of  “utmost importance not only for their personal well-being and safety but for the health of host communities” (Caulford and Vali). Another advantage is that migrants and refugees will be able to improve their quality of life by being healthier. The drawbacks of these solutions, however, are how expensive it would be to do as well as persuading countries nationwide on why it is a good idea as well as why they should participate in it. The access to crucial health services for refugees and migrants ought to be “recognized as a fundamental human right” (Langlois), as well entitle refugees “to the full range of NHS services free of charge” (Jones and Paramjit).

Counterargument

 However, many may say that these solutions are too costly and that migrants and refugees are not beneficial to their host countries in any way. In the article “The Fiscal Cost of Resettling Refugees in the United States”, Matthew O’Brien and Spencer Raley describe the overall welfare costs of refugees in the U.S, to be “…$867,004,000…” with healthcare assistance such as Medicaid costing “…$320,551,000…” out of the overall welfare total.  In the article by IOM, “Evidence Shows Primary Healthcare for Migrants is Cost-saving”, the director of the IOM Migration Health Division Director notes that “high costs are often cited by governments as the main reason to not include migrants in health systems,” implying that healthcare cost is not included in the total cost for welfare. Many may also say that migrants and refugees are not beneficial due to increased competition for jobs, which causes negative pressures on wages, therefore should not be rewarded with healthcare. However, the plausible solutions above prove for solutions that would allow all migrants and refugees to have healthcare access. Based on an article written by Paul Bedard, “Refugee costs: $8.8 billion, $80,000 per immigrant, free welfare, Medicaid”, the average cost of a refugee is $80,000 a year or $5,480,000,000,000 for all refugees and migrants. If the average cost of migrants and refugees were increased to $85,000 a year per refugee or $5,822,500,000,000 for all, all migrants and refugees will be provided adequate and affordable healthcare access who payback by contributing to society.

Migrants and refugees all contribute to the economic society, by the means of working which in turn is paying taxes. The article “Evidence Shows Primary Healthcare for Migrants is Cost-saving”, by the International Organization for Migration (IOM), discusses that

“…migrants contribute more in taxes than they receive in benefits, send remittances to home communities and fill labor market gaps in host societies. Equitable access for migrants to low-cost primary health care can reduce health expenditures, improve social cohesion and enable migrants to contribute substantially towards the development” (IOM).

Migrants and refugees are also beneficial to host countries in terms “… of keeping private costs for business firms low and ensuring the welfare of migrant workers justifies economically a fair health care policy for migrants…” (IOM),  providing a benefit of slightly lower taxes for private costs. IOM also discusses how restriction of access to healthcare is not cost-saving. A European vignette study discussed in the article by IOM provides evidence that migrants and refugees are actually cost-saving demonstrating the “…potential cost savings of timely treatment in primary care of 49 percent to 100 percent of the costs that occur for treatment of more severe medical conditions in hospital” (IOM). In the article “The Real Economic Cost of Accepting Refugees,” Michael Clemens, discusses that with “… the small number of native workers [that] are displaced by new migrants entering the workforce, those native workers end up in higher-paying, higher-skill jobs,” implying a benefit of accepting migrants and refugees. Clemens also discusses that many refugees “… open their own businesses and become employers, expanding their positive impact on the economy by creating jobs.” Migrants and refugees should be entitled to healthcare in return for helping boost economic growth which in turn increases wealth for all countries specifically host countries.

Conclusion

Healthcare is one of the most basic human necessity that sadly millions are excluded from. It is a human right to have access to healthcare, however with the way the healthcare system functions it makes it harder for migrants and refugees and many others to gain access to healthcare without the excessive out-of-pocket expenses for health services. There are many probable solutions that can help allow refugees and migrants to gain access to healthcare as well as help make it more affordable. The solution of a new healthcare system formation and/or the tax bill is very plausible and may prove to be slightly costly, but in the long run, will be a very successful and effective solution to help solve the issue of healthcare access for migrants and refugees.

Works Cited

• Abbas, Mohamed, et al. “Migrant and Refugee Populations: a Public Health and Policy Perspective on a Continuing Global Crisis.” US National Library of Medicine National Institutes of Health, NCBI, 20 Sept. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6146746/.
• Abubakar, Ibrahim, and Alimuddin  Zumla. “Universal Health Coverage for Refugees and Migrants in the Twenty-First Century.” BMC Medicine, BioMed Central, 26 Nov. 2018, bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1208-2.
• Caulford, Paul, and Yasmin Vali. “Providing Health Care to Medically Uninsured Immigrants and Refugees.” CMAJ, CMAJ, 25 Apr. 2006, www.cmaj.ca/content/174/9/1253.short.
• Clemens, Michael. “The Real Economic Cost of Accepting Refugees.” Center For Global Development, Center For Global Development, 14 Sept. 2017, www.cgdev.org/blog/real-economic-cost-accepting-refugees.
• “Evidence Shows Primary Healthcare for Migrants Is Cost-Saving.” International Organization for Migration, International Organization for Migration, 26 Oct. 2018, www.iom.int/news/evidence-shows-primary-healthcare-migrants-cost-saving.
• Jones, David, and Paramjit S. Gill. “Refugees and Primary Care: Tackling the Inequalities.” BMJ: British Medical Journal, vol. 317, no. 7170, 1998, pp. 1444–1446. JSTOR, www.jstor.org/stable/25181062.
• Langlois, Etienne V, et al. “Refugees: towards Better Access to Health-Care Services.” U.S. National Library of Medicine, NCBI, 23 Jan. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5603273/.
• Matsumoto, Monica, et al. “WHO EMRO | Health Needs of Refugees: Port of Arrival versus Permanent Camp Settings.” World Health Organization Regional Office for the Eastern Mediterranean, 22 Nov. 2016.
• “Migrant and Refugee Health Issues.” Global Issues in Context Online Collection, Gale, 2018. Global Issues in Context, http://link.galegroup.com.douglascountylibraries.idm.oclc.org/apps/doc/CP3208520498/GIC?u=cast18629&sid=GIC&xid=df12ad4b. Accessed 10 Apr. 2019.
• “Overcoming Migrants’ Barriers to Health.” World Health Organization, World Health Organization, 4 Mar. 2011, www.who.int/bulletin/volumes/86/8/08-020808/en/.
• Sundquist, Jan. “Migration, Equality, and Access to Health Care Services.” Journal of Epidemiology & Community Health, BMJ Publishing Group Ltd, 1 Oct. 2001, jech.bmj.com/content/55/10/691.
• United Nations. “Figures at a Glance.” UNHCR, UNHCR, 19 June 2018, www.unhcr.org/figures-at-a-glance.html.