Private healthcare provision
Private healthcare provision
Individuals who reside in a country without regular authorisation generally find it difficult to access public medical services beyond emergency treatment. Even in countries with universal healthcare, there is often a gap between rights on paper and their implementation. Civil society organisations (CSOs) fill this gap by providing medical services to vulnerable populations, including irregular migrants. What, if any, are the ethical dilemmas that arise for CSO staff when delivering such services in countries with universal healthcare? Under what conditions do these dilemmas arise? And what strategies do CSO staff use to mitigate them? We answer these questions using 40 semi-structured interviews with CSO staff working in two European countries with high levels of irregularity, universal healthcare provisions on paper, and significant differences in approaches and availability of public services for irregular migrants: Italy and Spain. We show that CSO staff providing medical services to irregular migrants in places with universal healthcare coverage face a fundamental dilemma between humanitarianism and equity. CSO staff respond to the humanitarian belief in the value of taking all possible steps to prevent or alleviate human suffering, thus promoting a decent quality of life that includes access to both emergency and non-emergency care. In doing so, however, they run the risk of substituting rather than complementing public provisions, thereby preventing governments from assuming responsibility for these services in the long term. Individuals who acknowledge the existence of this dilemma generally oppose the creation of parallel structures; that is, services specifically developed for irregular migrants outside the public system; while those who ignore it essentially subscribe to a tiered system, giving up on considerations of equity. We argue that CSOs involved in the provision of healthcare to irregular migrants do not simply provide services; they also play an inherently political role.
Adding to the original paper by Piccoli & Perna, this commentary highlights two dilemmas in CSO healthcare provision for irregularised migrants that are related to “exceptionalism”; i.e., to the framing of irregularised migrants’ exclusion from public healthcare and their relegation to parallel systems of provision as an exceptional phenomenon affecting only a few “Others”.
It argues that CSO healthcare provision, if justified as an exception, 1) runs the risk of undermining rights-based approaches to health, as the exclusion of one marginalised group from health rights is often a precedent for the gradual dismantling of the right to health altogether; and 2) obscures the normality with which liberalised economies produce, maintain and benefit from irregularity and precarity, which helps provide the cheap and flexible labour that is necessary to satisfy our daily needs and wants.
In a brilliant new article, Lorenzo Piccoli and Roberta Perna offer fresh insights into civil society groups that provide healthcare services to individuals with irregular migration status.
These groups appear inevitably torn between their mission to help anyone in need and the risk of fueling welfare state retrenchment—a tension the authors define as the humanitarianism-equity dilemma. In this comment piece, I put their discussion in dialogue with critical scholarship on welfare retrenchment, humanitarianism, and contentious politics.
Ultimately, I suggest that political activism presents an uneasy yet transformative path out of the humanitarianism-equity dilemma. Despite mobilising from the periphery, immigrant advocates wield strategic leverage to drive far-reaching political change while providing essential services to people with care needs but no regular status.