Changes between Health strand scores in the 2015 and 2020 rounds
David Ingleby (Affiliated Researcher, University of Amsterdam)
Averaged over all countries, total scores were slightly higher in the 2020 round (+3 points inthe average score), though in 28 out of 56 countries there was no change. Significant
improvements were only found on the dimensions Accessibility of health services, Responsive
health services, and Policies to promote change. For Entitlements, the total score averaged overall countries remained virtually the same, but there were both positive and negative changes in
the 6 separate indicators for this dimension.
The changes observed in countries’ total scores for Entitlements are shown in the table below.
In 39 countries no change in the total occurred. It is interesting to note that some changes (inSpain, Canada and Italy) were associated with a change of government.

Country
Indonesia

Spain

LatviaCanadaChile

Portugal

TurkeyCyprusEstonia
Lithuania
SerbiaChange Remarks
25,0 In 2015 asylum seekers received only limited services provided by IOMand UNHCR, but in 2020 they were able to join the national system ofhealth coverage (JKN), with no administrative barriers.
16,7 Coverage for undocumented migrants in Spain was abolished by theRajoy government through Royal Decree-Law 16/2012. After thegovernment fell in 2018, this coverage was restored through Royal
Decree-Law 7/2018. UDMs now have in principle the right to health care
under the same conditions as Spanish nationals. However, thisimprovement is offset by the increased complexity of the documents
required to access the system, which also differ between regions.
16,7 A new law in 2018 improved entitlements for asylum seekers andremoved the discretionary element associated with them.
8,3 In 2012 the Howard government reduced the entitlements of asylum
seekers under the IFHP (Interim Federal Health Programme), making
them dependent on the asylum seeker’s country of origin. After thechange of government in 2015 this change was abolished.
8,3 Following a change in the law in 2016, UDMs only have to sign adocument declaring that their resources are insufficient in order toaccess health care.
8,3 Since 2014 entitlement to health care for asylum seekers has been
dependent on their not having sufficient resources to cover the coststhemselves. In 2016 access was made unconditional.
8,3 Undocumented migrants or stateless persons, who qualify neither asasylum seekers nor as conditional refugees, now have access toemergency and primary health care services free of charge. Pregnant
mothers and children have the same coverage as nationals.
8,3 The new General National Health System (GHS) was implemented in
2019. Third country nationals are eligible for inclusion under certain
conditions.
8,3 There are now fewer administrative barriers for legal migrants.
8,3 Documentary barriers for asylum seekers were removed.
8,3 In 2019 “access to immediate health care depending on their needs” wasmade available to UDMs.

Argentina
Hungary
Italy
Netherlands

SwedenMexico-8,3 In 2019 some provinces adopted more restrictive laws concerning theentitlements of UDMs.
-8,3 Administrative procedures may now hinder access to care for asylum
seekers not living in camps.
-8,3 In 2018 administrative barriers for some asylum seekers increased under
the Salvini government.
-8,3 As of December 1, 2019, access to care for asylum seekers from the ageof 18 during the first two months of reception is limited to care that is
medically necessary and cannot be postponed.
-8,3 Due to a change in the law in 2016, former asylum seekers lose their socalled LMA card (which is not valid as an ID but is accepted as such atpharmacies) if their application is denied. Lack of ID creates difficulties
for UDMs in following up previous care, for example in maternal care.
-33,3 After 2015 administrative barriers increased for legal migrants andasylum seekers.

The next table shows the change in the average of scores on Accessibility of health services,Responsive health services, and Policies to promote change. Each of these scales correlated
more highly with the other two than with Entitlements, so the latter scale can be regarded aslargely independent of the others.
The policy changes in Turkey reflect efforts to improve service delivery for the large populationof Syrian refugees which had been building up in the country since the start of the war in 2011and gradually moved out of the camps to find their own way in Turkish society. Large mixed
migration flows to Europe in 2015 and 2016 are also reflected in improvements mainly directed
at asylum seekers, but sometimes also benefiting other categories of migrants. Four of theinterventions listed below were supported by the EC’s Asylum, Migration and Integration Fund(AMIF).

CountryTurkey

GreeceChange Remarks
36,0 Information is now provided for UDMs on their entitlements, healtheducation and health promotion.
Interpreters are now available not only in the camps for asylum seekers,
but also in migrant health centres, all private hospitals, and some statehospitals.
Migrants are now extensively involved in information provision, servicedesign and delivery.
Commitment to providing equitable health care for migrants or ethnic
minorities is now present in all departments of state-administeredservice provider organisations and health agencies
27,8 Asylum seekers living in camps are now reached by health education andhealth promotion.
In response to the large mixed migration flows to Greece, intercultural
mediators have been placed by the National Organization of Public
Health in the framework of the European AMIF project PHILOS inselected hospitals with high concentration of migrants.
Migrants are involved in service delivery through employment as cultural
mediators.

CanadaChile
LatviaUkraineBelgium
Slovakia
PolandCroatia

BrazilCzechia
FranceIreland
Portugal
Spain
Lithuania
PolandDenmark

19,3 In 2020 scores for provision of information to migrants on entitlements,
as well as health education and promotion, were higher than in 2015.
The availability of interpretation services has been improved.
16,7 In 2017 measures to stimulate research on migrants and their health,and to mainstream migration into the health system, were introduced.
16,7 Interpretation services are now provided free of charge, in mostlanguages except English or Russian, in a scheme co-financed by AMIF.
Research has also been supported on the mental health of migrants.
16,7 Since 2017, service providers are obliged to inform migrants about theirentitlements.
13,8 Health education and health promotion are extended to asylum seekers.
More involvement of migrants.
13,8 UDMs are now reached by information about entitlements.
More involvement of migrants.
11,2 Information about entitlements is now provided for legal migrants andasylum seekers.
11,2 Since 2017, asylum seekers receive information about their entitlements.
They are also reached by health education and health promotion(supported by an AMIF project).
8,3 In 2019 45% of all international migrants in Brazil were living in Sao
Paolo, where extensive efforts have been made (especially since 2015)
by the municipal authorities to provide ‘migrant-friendly’ health services.
8,3 More involvement of migrants.
8,3 More research on migrant health.
8,3 More research on migrant health.
8,3 Migrants are more involved in service delivery, through being employed
as cultural mediators.
8,3 There was a slight increase in the involvement of migrants in service
design and delivery.
8,3 Migrants are involved in information delivery through integration
projects supported by AMIF.
5,7 Information about entitlements is now provided for legal migrants.
-8,3 Legislation was introduced in 2018 confining free interpretation services
to patients who have resided in the country for less than 3 years.