Background:

The provision of healthcare services for applicants for international protection in Finland includes some ambiguities. For example, for certain healthcare services, it is unclear whether they should be organised by the reception centre or the public health system. In addition, aspects of the legislation remain unclear, which may complicate the functioning of the healthcare system.

For this reason, Finland is examining how the organisation of healthcare services for applicants for international protection could be improved. One key question is whether a complete reorganisation of these services should be considered to streamline and optimise their delivery. As a basis for this work, Finland required information on how healthcare services for applicants for international protection are organised in other EMN Member and Observer Countries.

Respondents:

26 EMN Member and Observer Countries, including BE, provided a public answer to this ad hoc query.

Findings:

A preliminary analysis of the ad hoc query results shows that:  

• In approximately half of the EMN Member and Observer countries, healthcare services for applicants for international protection are organised by the asylum authorities (e.g., HU) or the reception authority (e.g., NL), while in the other half, they fall under the public healthcare system (e.g., PT). However, this distinction is not always clear-cut, as it can depend on factors such as the category of applicants (e.g., newly arrived vs. those residing for several months in the country), the type of accommodation in which they reside (e.g., collective vs. individual, or emergency vs. permanent), the type of healthcare needed (e.g., primary vs secondary), and the region concerned (in decentralised countries where responsibilities are delegated to regions or Länder).
• More than half of the countries have healthcare staff in reception centres – sometimes only a nurse (e.g., CZ), sometimes also doctors (e.g., CY), and in some cases not permanently and not in all centres (e.g., FR). In some countries, healthcare personnel are employed by a service provider (e.g., EL). For further or specialist services, applicants are referred by the healthcare service to external medical facilities. In some countries, reception centres collaborate with a specific hospital or health centre (e.g., BE). Support from international organisations is also possible: in HR, there is no healthcare personnel included in the reception centre staff, but Médecins du Monde operates in reception centres. 
• Generally, the state will bear the costs of healthcare services for applicants for international protection. However, applicants may need to pay part of the costs, such as a co-payment (e.g., IT). Some countries also apply an income limit for state-covered costs (e.g., IE).
• Healthcare services for adult applicants for international protection vary significantly across countries. Some countries provide comprehensive healthcare, including primary, secondary, and specialised care, with few restrictions. Others focus mainly on emergency and essential care, including specific services for mental health and maternity. In some countries, the level of entitlement increases after a certain period. For example, in LU, applicants initially receive urgent and essential care for the first three months, after which they gain access to healthcare equivalent to that of Luxembourg residents. 
• Regarding the organisation of health services during a mass influx of migrants, different countries express concerns, stating that they would face challenges as they have no specific contingency plan in place. Others indicate that healthcare would be limited to emergency services only (e.g., FI). A few countries have a specific emergency plan for mass migratory flows, which includes the provision of additional personnel from the Ministry of Health to respond to the crisis (e.g.,  CY).

For further details, please refer to the attached compilation of responses.