What health care for undocumented migrants in Belgium?
Authors: Roberfroid Dominique , Dauvrin Marie , Keygnaert Ines , Desomer Anja , Kerstens Birgit , Camberlin Cécile , Gysen Julie , Lorant Vincent , Derluyn Ilse 
Published: January 2025

LIST OF FIGURES 4 -- LIST OF TABLES.4 -- LIST OF ABBREVIATIONS 6 -- SCIENTIFIC REPORT.7 -- 1 BACKGROUND 7 -- 1.1 WHO ARE THE UNDOCUMENTED MIGRANTS? 7 -- 1.2 WHAT IS URGENT MEDICAL AID? 8 -- 1.3 WHY DOES UMA MATTER? 8 -- 1.3.1 Human rights.8 -- 1.3.2 Public health 9 -- 1.3.3 Costs 9 -- 1.4 CHALLENGES 10 -- 2 OBJECTIVES10 -- 3 METHODS 11 -- 4 SITUATION ANALYSIS 12 -- 4.1 METHODS 12 -- 4.1.1 Interviews 12 -- 4.1.2 Routine data analysis.12 -- 4.2 HOW DOES UMA WORK? 13 -- 4.2.1 What are the conditions for UMA agreement? 13 -- 4.2.2 What decision can the CPAS  OCMW make? 16 -- 4.3 HOW MANY INDIVIDUALS ARE CONCERNED?.17 -- 4.3.1 What are the global numbers? 17 -- 4.3.2 Is their geographical distribution? 17 -- 4.3.3 What is the health coverage? 21 -- 4.4 WHAT TYPE OF HEALTH PROBLEMS? 21 4.5 HOW MUCH DOES IT COST? 22 -- 4.5.1 Who is the payer? 22 -- 4.5.2 What is the annual budget? 23 -- 4.5.3 Are there geographical variations? 27 -- 4.5.4 How does this compare to expenses by individuals in the INAMI  RIZIV? 29 -- 4.5.5 Are there controls? 29 -- 4.5.6 Is migration for health reasons documented?30 -- 4.6 WHAT ARE THE PROBLEMS IDENTIFIED DURING THE SITUATION ANALYSIS? 30 -- 4.6.1 Variations in social enquiry and rejection rate 30 -- 4.6.2 Variation in entitlement to health care31 -- 4.6.3 How big is the administrative burden? 31 -- 4.6.4 MediPrima 32 -- 4.6.5 Free choice of health practitioner.33 -- 4.6.6 Difficult communication 33 -- 4.6.7 Difficult monitoring of practices and costs 33 -- 4.7 WHAT ARE THE GOOD PRACTICES IDENTIFIED DURING THE SITUATION ANALYSIS? 33 -- 4.8 DISCUSSION 35 -- 5 SWOT ANALYSIS OF URGENT MEDICAL AIDa 35 -- 5.1 INTRODUCTION.35 -- 5.2 METHODOLOGY 36 -- 5.2.1 Advisory board of key informants.36 -- 5.2.2 Interviews with undocumented migrants 37 -- 5.2.3 Focus groups with health care professionals and managers.41 -- 5.3 RESULTS: THE SWOT MATRICES 43 -- 5.3.1 Legal and political framework and procedures 44 -- 5.3.2 Provision and quality of urgent medical aid for undocumented migrants 49 -- 5.4 CROSS-CUTTING THEMES 54 -- 5.4.1 Four areas of challenges and problems 55 -- 5.4.2 Four areas of potential improvements and solutions 69 -- 5.5 DISCUSSION 80 -- 6 LESSONS LEARNED FROM OTHER COUNTRIES 83 -- 6.1 LITERATURE REVIEWb 83 -- 6.1.1 Objective 83 -- 6.1.2 Methodology of the literature review 83 -- 6.1.3 Results 85 -- 6.2 COMPARATIVE ANALYSIS OF SELECTED EUROPEAN COUNTRIES.90 -- 6.3 REGULATIONS ABROAD AS INSPIRATION FOR BELGIUM? 93 -- 7 RECOMMENDATIONS FOR A REFORM OF UMA 100 -- 7.1 FACILITATING THE DEMAND FOR MEDICAL AID 100 -- 7.2 STREAMLINING THE SOCIAL ENQUIRY 100 -- 7.2.1 Health coverage during the social enquiry100 -- 7.2.2 Streamlined social enquiry100 -- 7.3 STANDARDIZING THE MEDICAL CARD. 101 -- 7.4 HARMONIZING HEALTH CARE WHICH ARE COVERED101 -- 7.5 RATIONALIZING THE UTILIZATION OF HEALTH CARE 102 -- 7.6 SIMPLIFYING THE FINANCING 102 -- 7.7 ENSURING CONTINUITY OF CARE AND INFORMATION 102 -- 7.8 IMPROVING COMMUNICATION.102 -- 7.9 ENHANCING MONITORING AND EVALUATION 103 -- BIBLIOGRAPHY 105 -- APPENDICES 111