Imagine being a nine-year-old child in excruciating pain with no place to obtain medical treatment while in an unfamiliar country. This horrifying nightmare is a reality to many migrants living in Italy. Just two weeks ago at the Joel Nafuma Migrant Center on Via Nazionale in Rome, a young nine-year-old boy was faced with this exact situation. Hit by a car while crossing the street, he acquired numerous injuries to his left leg and was unable to walk. He was a refugee from Afghanistan making his way through various countries in Europe in hopes of reaching Norway, a place where migrants receive the best benefits. His friends hovered around him reassuring the many worried onlookers that he was fine and did not need medical attention. The young boy’s excruciating expression told otherwise. Without the proper papers in Italy, it becomes complicated to receive medical attention. His guardians were worried that their illegal status in Italy would be disclosed if they brought him to a doctor. Sandra, a volunteer at the migrant center, decided to take her chances and brought him to a hospital. She had to go to three different hospitals until medical professionals finally saw the young boy. As one can see, the Italian health care system is very complex, especially concerning health care of undocumented migrants.
There are many complex regulations in Italy in terms of who can be covered by the country’s public health care. These regulations range from a person’s legal status in Italy to the severity of illness. In this paper, the state policy in Italy for migrants compared to legal residents will be examined in terms of their access to health care. In addition, the correlation between this policy and the realities of health care practices for migrants will be assessed. The term migrants, as used in this paper, means everyone who has moved to Italy whether their move was by choice such as for an immigrant or forced such as for a refugee. The term undocumented refers to those who are not registered with the Italian government and are illegally in the country. These terms will be used throughout to better understand the complex Italian health care system and how it pertains to undocumented migrants.
-METHODS-
Information on this topic of Italian healthcare for undocumented migrants as well as legal residents was gathered from a variety of sources. The Joel Nafuma Migrant Center provided great insight on how these undocumented migrants receive care. Sandra, a volunteer for many years at the center, has a lot of personal experience dealing with these migrants at the center and was very gracious to share her experiences. In addition to Sandra, I was also able to speak with Sina who is a nursing student in Rome who volunteers his time at the Joel Nafuma Migrant Center. Sina, even with the language barrier, was able to provide a lot of valuable insight on how undocumented migrants get into contact with doctors to receive the care they need. The staff at CARITAS also provided valuable information, especially Anna Galdo who is the research and projects officer in the asylum and migration department. The internet also served as a valuable source. Such journals as The European Journal of Health Law and The Health Economics Journal provided information on the Italian health care system. Other internet websites were informative by providing statistics as well as the current health care issues in Italy.
-FINDINGS-
According to the World Health Organization (WHO), Italy has the second highest rated health care system in the world (Healthcare Economist). Italy guarantees the uniform provision of comprehensive care throughout the country (France). Italy’s national health system, called Sercizio Sanitario Nazionale or SSN for short, receives funding from a regressive payroll tax, social insurance contributions as well as co-payments. In-patient and primary care are free yet tests, diagnostic procedures and prescription drugs require co-payments as high as thirty percent. However, forty percent of the population, which includes the elderly, pregnant women as well as children, is exempt from these co-payments (Healthcare Economist). Emergency health provisions are available to all EU and non-EU visitors. No matter where one comes from, it is mandatory to have some form of health insurance upon arriving in Italy. A permesso di soggiorno, or residency permit, will not be issued without it (Healthcare Economist).
Despite the high rankings by the WHO, Italians are dissatisfied with the quality of their health care. Italians believe that patient choice will improve the quality of care, yet reform is unlikely to happen anytime soon. Waiting times are also a prevalent problem in the current health care system. For diagnostic tests, the average wait for a mammogram is seventy days and for endoscopy seventy-four days (Healthcare Economist). In addition to long waiting times, the sanitary condition of many hospitals is unacceptable. Overcrowded rooms often are filled with lice while patients are served uneatable foods (Health System in Italy). Many opt to pay for private health care as a result of these conditions. Also, the health care system is complicated by the fact that constitutionally, responsibility for health care is shared between the central government and the twenty regions. There are large disparities in regional health service organization and provision (France). In addition, coverage differs greatly depending on one’s legal status. As a result of all these impediments in the health care system, many within Italy are unsatisfied with the Italian health care system.
There are many ways for people to get insured and be covered under this health care system. These include working in Italy, being a EU citizen visiting Italy or simply being an Italian citizen. If you are working in Italy, the employer pays your health insurance. All you need to do is go to your local health authority and register with a doctor at the health convention. A health number is then created along with a health card, which can be used to have all visits to a family doctor be covered. If you are an EU citizen visiting Italy, you can take advantage of reciprocal health agreements. This can be done by simply going to the ufficio staniero (foreigner’s office) and filling out paperwork to cover your temporary stay (Health System in Italy).
Obtaining health care if you do not fit into these categories becomes a little more complicated. My talk with CARITAS’s Anna Galdo informed me that with the correct paperwork, immigrants are treated in the same manner as Italian citizens. The current legislative provisions concerning health care for illegal immigrants can be found in Article 35 of the Legislative Decree No. 286 in July 1998. The article is organized according to several principles including human dignity, health need and solidarity with the most vulnerable people (Romero- Ortuno). This includes having equal rights for everyone irrespective of personal or social characteristics. In addition, everyone in need is granted a right to health care. The article states how illegal immigrants in Italy have the right to receive urgent and essential primary care due to illness or accident, with guarantee of continuity of care (Romero-Ortuno). In addition, migrants are covered for pregnancy and maternity care, full health care for everyone under eighteen as well as vaccinations according to the rules and within the areas of intervention set by the regions. Their health care even extends to diagnosis and treatment of infectious diseases and prevention, treatment and rehabilitation of toxic dependencies (Romero-Ortuno).
In order to receive these benefits, illegal immigrants must fill an official form self-declaring that they lack sufficient economic resources (Dichiarazione di Indigenza). In return they will be given an anonymous ID regional code (Codice Staniero Temporaneamente Presente) which is valid for six months. With this code they can receive all of the benefits listed above and be treated under the same conditions as Italians. The regional health authority refunds the provider for all expenses. In addition, an illegal immigrant cannot be reported to the authorities (Romero-Ortuno).
Health care for undocumented migrants gets tricky when these migrants fail to obtain these documents. From my talk with Sandra, an avid volunteer from the Joel Nafuma Migrant Center, I have learned that even without documents it is possible for illegal immigrants and refugees to receive care, even if it is breaking laws. According to Sandra, there are certain hospitals in Rome that do not check for documents and turn their head in order to give care to those in need. Sandra mentioned the Ospedale Nuovo Regina Margherita in the Rione Trastevere as a good hospital for immigrants without documents to go and receive care. According to Sina, a nursing student who volunteers his time at the Joel Nafuma Migrant Center, these hospitals take the people’s name and number without contacting the police. In Sina’s words, “this is a way to break the law and do the right thing.”
Overall, migrants either documented or undocumented are able to get access to health care in Italy even if they do so illegally. Migrants who do not have their papers might come up against barriers to receiving care at certain hospitals, but there are places that are open to helping everyone. This type of information is important to pass along to all migrants in order to ensure good health for everyone.
-DISCUSSION-
Many believe Italy has a very strong health care system in place. Their health care system is set up to offer care to the majority of Italy’s population with little or no copayment. As long as one has the correct paperwork, whether they are an Italian citizen, illegal migrant or legal migrant, they will be covered under the Italian health care system. Other than the bad conditions of long wait times and unsanitary hospitals, the health care system basically has been proven to be successful in ensuring good health for the majority of the population. However, a major problem this system sustains is its inability to provide coverage for undocumented migrants.
This issue of health care for undocumented migrants in Italy has become a pressing topic. There are those who believe that if one is not paying taxes, then they should not be entitled to health care. Aiding these undocumented migrants without papers only puts the Italian health care system further into debt. On the other side, others wonder if it is ethically right to deny someone health care. This is the current topic being debated.
Although some migrants might know these particular hospitals that do not check for paperwork, many others must simply go without help. Changes must be made to this current health care system in order to ensure good health for all. The Italian health care system needs to be prepared for Italy’s changing identity. According to Sylvia Poggioli’s film titled “Immigrants Forced to Margins of Italian Society,” Italy has the fastest growing immigrant population in the world. This film states that immigrants constitute seven percent of the Italian population. Ever since the mid 1980’s, Italy has imported people from many vicinities including Northwest Africa, South and Southeast Asia as well as South America (Grillo). Italy’s identity is shifting to becoming a multi-cultural country (Wong).
With migration in Italy playing such a large role in today’s society, adaptions must be made to fully include all migrants, whether legal or illegal and with or without paperwork, into the health care system. Access to health care is an integral part of living long healthy lives. Opening the doors at hospitals across Italy for these undocumented migrants would promote good health. Making adaptions to the Article 35 to include ways undocumented migrants can receive care legally will in turn result in better health for all.
There are many problems precipitated by these illegal actions of providing migrant health care. Article 35 of the Legislative Decree No. 286 written in July 1998, relates that there are equal rights for everyone irrespective of personal or social characteristics. In addition, everyone in need is guaranteed a right to health care. According to the findings provided, this universal coverage does not seem to be the case. Undocumented migrants, who do not possess the correct paperwork, are not given equal opportunity to health care in Italy. They are forced to go to the select hospitals that break the law and do not check the migrants’ papers. These illegal practices are hotly debated in Italy since caring for these undocumented migrants puts the Italian health care system further into debt. The Italian health care system has an average deficit equal to $2.5 billion US dollars per year (Maio). These illegal migrants only further the situation. This question of whether these hospitals should care for these migrants given that this care comes at a price is a major issue at hand. Both sides cause issues for either the migrant or financially for the Italian health department.
-CONCLUSION-
In the end, there is a very complex health care system set up in Italy. This system is designed to cover Italian citizens, EU visitors and documented migrants will little or no copayment. Undocumented migrants, on the other hand, are only covered under extreme circumstances. These include such circumstances as urgent and essential primary care. Although there are certain hospitals that turn their heads in order to help, more needs to be done to enable all hospitals to treat these undocumented migrants. Italy’s identity is slowly shifting as a result of the high prevalence of immigration. With so many immigrants, the health care system needs to change in order to promote the well being of the entire population. It is important for changes to occur so that situations such as the one the young Afghanistan boy was faced with will no longer need to occur. Though this investigation, only more questions are asked pertaining to Italy’s health care system and its involvement with migrants. The future of this health care system and how it decides to deal with this high flow of immigrants into the country is a pressing concern for Italy.
When gathering information on this topic of access to health care for undocumented migrants, there were many barriers. Since this topic deals with issues involving breaking the law in order to help migrants get care, many were unwilling to talk about specifics on the issue or their involvements. Only after reassuring people that this information would solely be used for educational purposes would people be willing to share information and still I felt as if I were not getting the entire story. In addition to the barrier of having people not want to share information that could get them in trouble with the police, it was also difficult to uncover information about how undocumented migrants received care. Nothing had been published on the issue stating how illegal migrants broke the law to receive care. The only information gathered on the issue was from speaking with knowledgeable people on the issue. Overall, there were many hindrances to dealing with a topic so bound up in legal regulations.
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