Access to health care

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In the absence of regularisation measures until 1998, exclusion from formal access to the National Health System was a de facto situation resulting directly from the migrants' legal status. Legalisation is a recent development for the majority οf migrants and, even so, the share of those without insurance is high enough, at about 40-50 per cent, as recent empirical studies reveal (Labrianidis and Lyberaki 2001; Hatziprokopiou 2004b). Lack of insurance means that migrants themselves have to pay in full for medical treatment, which is clearly too costly for most. Current trends, however, reveal a gradual improvement in the position of immigrants, as increasingly more acquire legal status and find regular employment, thus securing legal access to the National Health System: by early 2000, nearly 213,000 immigrants were registered with the three main Greek Social Security Funds (Eleftherotypia, 03.03.02), thus guarantying access to health services for themselves and their families.

However since 2004 (last regularisation law: 3386) no new opportunity for regularisation has existed. «That means that in our country an unknown but constantly increasing number of aliens who enter the country illegaly, stay without papers and do not have any chance of access to social care.» (Μigrants: Slaves of the New Order, Εleftherotypia, 6/05/2008).

Nevertheless, during the period previous to the regularisation campaign, there was space for access to basic welfare services. Despite the lack of relevant provisions, many migrants have been able to benefit from certain public services, due to specific legal provisions but mostly due to gaps in the practical implementation of the policy framework. Informal practices and support from social networks have also played a positive role. There are many examples of unofficial help from both doctors and administrative staff at public hospitals or even in the private sector (Hatziprokopiou 2004a).

Various additional strategies have been observed. Some found out about, applied and have been eligible for special welfare programmes (Pronoia) which offer access to health services and other benefits for low-income people. Obviously, this is not a viable choice, as it does not apply to everyone (only immigrants of ethnic Greek origin are eligible). A rather common practice among undocumented migrants for accessing public hospitals was the use of emergency services: recent unpublished research shows that the share of foreign patients using the emergency services in a major Thessaloniki hospital was as high as 58.8 per cent among those insured and reached 88 per cent among those without insurance (Hatziprokopiou 2004a). This strategy was so widespread that the 2000 Circular provided for special (border) police units to patrol public hospitals, after medical and administrative staff objected to informing the authorities about undocumented patients.

There are no signs of systematic discrimination or exclusion, and cases of maltreatment by doctors or hospital staff should be considered as rather rare and isolated events. Such events do exist, however. Research by Psimmenos and Kasimati (2003) points to the problems of extending health services to newcomers at a period of welfare transition, with persistent national identity considerations by health care officers and practitioners who see immigrants as a 'threat' to the existing structures. More importantly, barriers to access appear to be bureaucracy, overcrowding, inadequate infrastructure and other chronic problems of the Greek health system, which affect negatively the quality of the services provided (Hatziprokopiou 2004a). Finally, a lack of relevant information or of access to information, due to language difficulties, for example, limits immigrants' knowledge of procedures and excludes them from the use of certain benefits and rights to which they might be entitled. Communication barriers seem to be important, not only regarding access to health as such, but mostly in respect to information, negotiation and communication with health care administrators and providers (IAPAD 2002).

A recent survey by the Medecins du Monde European Observatory on Access to Health Care No papers? No Health?also demonstrates that obstacles to health care access are widespread in Greece. Data from Greece was collected for 112 undocumented migrants visiting two reception and treatment polyclinics of Medecins du Monde in Athens and Thessaloniki. In a question concerning the awareness of HIV screening services, 83.7% of the people questioned answered that they are not aware of their right to access such services. This is by far the highest proportion compared to the other 8 European countries surveyed. "The result can be seen as an effect of the denial of the right to health care largely affecting undocumented migrants: the general rule is that they have no right to care, so the few exceptions to that rule (in that instance access to free HIV screening) are, understandably but unfortunately, poorly known".

Bibliography on migrants accessibility to health care

Newspaper articles on migrants accessibility to health care

Organizations and institutions providing health care services to migrants, refugees, minorities