Towards universal health coverage in Norway?
Undocumented migrants in Norway do not have access to universal health coverage. The Norwegian public health service provides emergency medical care, but this can be costly. There are relatively few private providers of medical services, and the out-of-pocket payments can be very high. The home countries of undocumented migrants rarely provide health services. Undocumented migrants thus find themselves in a situation where their access to healthcare services is restricted by law, and where financial and other practical barriers further restrict their access to medical care.
Access to healthcare services for undocumented migrants is often linked to immigration policy. Restricting access to the welfare system may be seen to form a part of this strategy; migrants should never be seen to benefit from gaining illegal access to the country (10). Liberal access to healthcare services for undocumented migrants may be considered to encourage ‘health tourism’ in that people in ill health may choose to migrate to Norway for the purpose of accessing expensive treatments such as cancer drugs or treatment against auto-immune diseases. However, very few undocumented migrants quote access to health services as a reason for migrating to an EU country (16). In humanitarian and professional healthcare circles there is broad consensus that medical treatment must be offered based on need rather than legal status. This view is founded on weighty ethical arguments (17). The Norwegian Medical Association, Norwegian Nurses Organisation and eleven other organisations launched an appeal to improve access to health services for undocumented migrants in Norway (18). Earlier this year, the Norwegian parliament rejected a proposal to increase access to primary health services for undocumented migrants and to work up funding arrangements for these services (19). One of the main arguments against the proposal was the fear of health tourism. In these discussions, Minister of Health Bent Høie stated that he did not see a need to consider extending the healthcare rights of migrants without an indefinite leave to remain (20).
Countries move towards the UN’s Sustainable Development Goals on different paths. As other countries take steps towards universal health coverage, Norway should also consider its current strategies. According to the World Health Organisation’s recommendations, universal health coverage is best achieved by gradually increasing access to health services. It is recommended that essential services should be prioritised. When services are provided free of charge, or at a low cost, they will be accessible even to vulnerable groups (21). It is difficult, in theory as well as in practice, to come up with a definition of essential healthcare services. Many may agree that experimental cancer treatments or rehabilitation programmes cannot be considered essential healthcare services, but that treatment for diseases such as diabetes, or the provision of maternity care, is. In discussions about universal health coverage in Norway, it is necessary to clarify which healthcare services should be offered to undocumented migrants. In order to safeguard their fundamental right to the highest attainable standard of health, it is crucial that they are given affordable access to essential health services. Services such as caesarean sections and treatment for pneumonia should therefore, in most cases, be provided free of charge.
The UN’s Sustainable Development Goals and our obligation to protect human rights challenge the practical, legal and financial organisation of healthcare services made available to undocumented migrants in Norway. For Norway to be able to claim that universal health coverage is provided, it is necessary to ensure access to further essential healthcare services for undocumented migrants, and the level of out-of-pocket charges must be reduced.