Narrative change for inclusionary health and migration policies

Several papers in this Series on “Addressing migration and health inequity in Europe” reflect discrepancies between Universal Health Coverage (UHC) ambitions and the actual exclusion of many migrants from national health systems. Amidst increasingly hostile discourses towards migrants, we argue that endeavours for UHC should not only address “implementation gaps”, but challenge the narratives fuelling these discourses.

Evidence shows that the costs of restricting migrants’ access to healthcare outweigh the benefits. In Germany, restrictions on asylum-seekers’ healthcare were shown to compromise health equity, efficiency, and other health system outcomes, including up to 40% higher expenditures.1,2 The 2015 NHS charging regulations in the UK have aggravated health inequities and adverse public health outcomes, thus potentially increasing costs.3 In Spain, the 2012 Royal Decree-Law restricted undocumented migrants’ access to healthcare, with adverse public health and economic effects.4 Still, exclusionary narratives advocate for restricting migrants’ health entitlements as a means to safeguard resources, invoking welfare nationalism and portraying migrants as ‘free-riders’ and presumed burdens on health systems.