Periodic Reporting for period 1 - EU-TRHeaDS (EU Citizens' Transnational Rights and Health-related Deservingness at the Street-level)
Berichtszeitraum: 2021-08-30 bis 2023-08-29
Guaranteeing healthcare rights for mobile EU citizens is a precondition for free movement in the Union, and supranational laws have fostered progressive coordination across Member States in this domain. Nevertheless, significant obstacles in accessing healthcare for mobile EU citizens have been frequently reported, revealing the existence of bureaucratic and administrative barriers that affect the realisation of this right at the point of access to Member States’ health systems. Hence, addressing the complex equilibrium between mobile EU citizens’ cross-border rights and Member States’ national health systems appears critical, particularly in times of renewed debates on ‘Social Europe’ and the challenges posed by COVID-19 to intra-EU mobility and healthcare systems.
The EU-TRHeaDS project investigates how different health systems interact with intra-EU mobility, focusing on the differences in healthcare solidarity in policies and public attitudes. At the level of policies, the project aims at reconstructing the evolution of the EU and national frameworks regulating the access to residency and healthcare rights for different categories of mobile EU citizens, paying particular attention to the existence of administrative and bureaucratic barriers on the front-line of health systems and the politicisation of the healthcare/intra-EU mobility nexus over the last decades. At the level of attitudes, the project aims at understanding what criteria do individuals mobilise to assess the ‘deservingness’ of mobile EU citizens to access healthcare in another Member State, whether these assessments differ between the general public and health professionals, and the extent to which they turn into systematic discrimination against mobile EU citizens.
The EU-TRHeaDS project investigates how different health systems interact with intra-EU mobility, focusing on the differences in healthcare solidarity in policies and public attitudes. At the level of policies, the project aims at reconstructing the evolution of the EU and national frameworks regulating the access to residency and healthcare rights for different categories of mobile EU citizens, paying particular attention to the existence of administrative and bureaucratic barriers on the front-line of health systems and the politicisation of the healthcare/intra-EU mobility nexus over the last decades. At the level of attitudes, the project aims at understanding what criteria do individuals mobilise to assess the ‘deservingness’ of mobile EU citizens to access healthcare in another Member State, whether these assessments differ between the general public and health professionals, and the extent to which they turn into systematic discrimination against mobile EU citizens.
To address EU-TRHeaDS’s main questions, the project combined qualitative policy analysis methodology with an online survey experiment in Belgium and Spain. Qualitative policy analysis methodology was used to reconstruct and compare the institutional, political and policy contexts of Belgium and Spain, focusing on differences in healthcare solidarity ‘in policies’. The qualitative fieldworks conducted in the two countries consisted in the collection of the data from official documents and semi-structured interviews with key stakeholders. As a result of this activity, two descriptive reports were produced and they are publicly available in the EU-TRHeaDS project website.
To understand what criteria do individuals mobilise to assess the ‘deservingness’ of mobile EU citizens to access healthcare, an original online survey experiment was carried out with a representative sample of the population in Belgium and Spain. The conjoint experiment consisted in asking respondents to prioritise the access to healthcare among pairs of fictitious but highly plausible healthcare claimants, whose attributes represented a combination of deservingness criteria (nationality, residence status, occupational status, responsibility over the illness). Moreover, the online survey included additional items to account for other variables that may explain healthcare chauvinist attitudes.
Despite the early termination of the fellowship (obtention of a research and teaching position), several dissemination/communication activities have been carried out, including the writing of two publicly available descriptive reports, one scientific publication (a chapter for an edited book), and the participation in two reputed international conferences, where the Fellow acted as paper presenter and panel chair/discussant (19th IMISCOE Annual Conference; 2022 ECPR General Conference).
Moreover, she has been invited to contribute to public outreach activities on the migration-healthcare nexus, including: the participation as invited speaker in a public workshop on the role of migrants in guaranteeing the sustainability of welfare states; the publication of a non-scientific article on the access to healthcare for migrants with precarious legal status in the context of the French Presidential election.
Finally, to raise students’ awareness about bureaucratic barriers to healthcare and encourage career in research, the Fellow organised a role game with master students of the University of Liège, which replicated the survey experiment but in a simpler way and for non-scientific purposes.
Despite the early termination of the fellowship, other dissemination/communication activities are expected to be carried out in the following months (submission of four scientific articles using the qualitative and quantitative data collected; organisation of an open webinar; writing of a non-scientific article for the general public).
To understand what criteria do individuals mobilise to assess the ‘deservingness’ of mobile EU citizens to access healthcare, an original online survey experiment was carried out with a representative sample of the population in Belgium and Spain. The conjoint experiment consisted in asking respondents to prioritise the access to healthcare among pairs of fictitious but highly plausible healthcare claimants, whose attributes represented a combination of deservingness criteria (nationality, residence status, occupational status, responsibility over the illness). Moreover, the online survey included additional items to account for other variables that may explain healthcare chauvinist attitudes.
Despite the early termination of the fellowship (obtention of a research and teaching position), several dissemination/communication activities have been carried out, including the writing of two publicly available descriptive reports, one scientific publication (a chapter for an edited book), and the participation in two reputed international conferences, where the Fellow acted as paper presenter and panel chair/discussant (19th IMISCOE Annual Conference; 2022 ECPR General Conference).
Moreover, she has been invited to contribute to public outreach activities on the migration-healthcare nexus, including: the participation as invited speaker in a public workshop on the role of migrants in guaranteeing the sustainability of welfare states; the publication of a non-scientific article on the access to healthcare for migrants with precarious legal status in the context of the French Presidential election.
Finally, to raise students’ awareness about bureaucratic barriers to healthcare and encourage career in research, the Fellow organised a role game with master students of the University of Liège, which replicated the survey experiment but in a simpler way and for non-scientific purposes.
Despite the early termination of the fellowship, other dissemination/communication activities are expected to be carried out in the following months (submission of four scientific articles using the qualitative and quantitative data collected; organisation of an open webinar; writing of a non-scientific article for the general public).
The EU-TRHeaDS project contributes to the study of healthcare solidarity in the Union in different ways. Accordingly, existing studies on the topic have already pointed out the ‘restrictive turn’ taking place in supranational laws and Member States’ measures limiting mobile EU citizens’ welfare entitlements. Shifting the focus to policy implementation dynamics in healthcare, the qualitative fieldwork identified the existence of systematic administrative and bureaucratic barriers that may affect the realisation of the right to healthcare for mobile EU citizens. Importantly, the comparative study revealed how these barriers do not substantially differ across healthcare systems (Social Insurance Scheme based on occupational status in Belgium; National Health Service based on residency in Spain). Rather, they are mainly associated with the administrative formalities tied to the assessment by local bureaucracies of the residency criteria set by the EU law. As the findings point out, administrative processes of residence registration can have exclusionary effects on mobile EU citizens’ access to healthcare, revealing a tension between free movement and bounded social rights in the Union. Moreover, the quantitative part of the research addressed three main gaps in the literature on public preferences towards welfare solidarity. First, it shifted the focus from welfare to health deservingness, the latter representing a topic largely overlooked to date. Second, it addressed potential deservingness hierarchies within EU nationalities and migration statuses, rather than considering ‘EU citizens’ as a homogeneous group. Third, it analysed differences across countries and healthcare regimes, moving beyond existing single-case studies.
By delving into administrative procedures and public attitudes, EU-TRHeaDS contributes to broadening our understanding of the existence of obstacles in policies and practices - including prejudice and even discrimination - that may affect the realisation of the right to healthcare for mobile EU citizens. The participation of national policy-makers and local bureaucrats in the research, as well as the dissemination and communication activities planned/realised so far, are contributing raising awareness among scholars, key stakeholders, students and the general public about the ways in which administrative barriers and pre-conceptions about the healthcare-mobility nexus may hinder the realisation of this fundamental right in the Union.
By delving into administrative procedures and public attitudes, EU-TRHeaDS contributes to broadening our understanding of the existence of obstacles in policies and practices - including prejudice and even discrimination - that may affect the realisation of the right to healthcare for mobile EU citizens. The participation of national policy-makers and local bureaucrats in the research, as well as the dissemination and communication activities planned/realised so far, are contributing raising awareness among scholars, key stakeholders, students and the general public about the ways in which administrative barriers and pre-conceptions about the healthcare-mobility nexus may hinder the realisation of this fundamental right in the Union.