Access to health care for undocumented migrants in

Contexte ©KCE 2015 Procédure d’aide médicale urgente Retrieved from Roberfroid et al, 2015, p

33 interviews & 6 focus groups 33 undocumented migrants • 17 women (9 pregnant)

Definition of « urgent medical aid » What does it mean ? Do I

Information & communication Sometimes we have to break the patient confidentiality to save the

Complexity of procedures It’s a bit difficult, it’s a lot of papers. For this

Discretionary power at all levels So the social worker told me « Who are

Why are we waiting? • Growing gap between the law and the practice •

KCE Belgian Health Care Knowledge Center Dominique Roberfroid, Anja Desomer, Cécile Camberlin UCL –

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Access to health care for undocumented migrants in Belgium: why are we still waiting for progress? Marie Dauvrin*, Ines Keygnaert, Julie Gysen, Birgit Kerstens, Ilse Derluyn, Vincent Lorant

Contexte ©KCE 2015 Procédure d’aide médicale urgente Retrieved from Roberfroid et al, 2015, p 21 Dauvrin - MERH 2018 2

33 interviews & 6 focus groups 33 undocumented migrants • 17 women (9 pregnant) • 28 UM aged between 26 & 55 years • 21 UM with children • 19 UM living in Belgium over 5 years • 25 UM from North Africa & sub-Saharan Africa 76 professionals • Health & social professionals and managers • 34 primary health care professionals • 29 from hospitals • 13 of specialized health care services • 5 Belgian cities Dauvrin - MERH 2018 3

Definition of « urgent medical aid » What does it mean ? Do I have to fall dead first? Extract from an interview with an undocumented person Dauvrin - MERH 2018 4

Information & communication Sometimes we have to break the patient confidentiality to save the patient. Either you have an empathic social worker, either you have a social assistant who doesn’t want and you have luck or not. Extract from a focus group The doctor prescribed 4 sessions per week, he did all the possible exams, even a heart puncture, but the local welfare center said: 2. The doctor was so angry. Extract from an interview Dauvrin - MERH 2018 5

Complexity of procedures It’s a bit difficult, it’s a lot of papers. For this pregnancy, I have an appointment with the gynecologist tomorrow for the monitoring, but I have to go to the local welfare center first to get a ticket before. There [at the hospital] they have to fill in a paper that I have to bring back to the local welfare center that prove I really went there [to the gynecologist], otherwise, without the document, they [the local welfare center] don’t do the reimbursement. Extract from an interview Dauvrin - MERH 2018 6

Discretionary power at all levels So the social worker told me « Who are you? How are you going to give birth if you don’t give the address? Go on, go on! » (makes the gesture of going back) and she pushes me to the door « if you don’t tell the address, I can’t do anything for you » Extract from an interview Dauvrin - MERH 2018 7

Why are we waiting? • Growing gap between the law and the practice • Unbalanced power between social and health workers • “Control freak syndrome” of social workers • Illusion of therapeutic freedom for health professionals • Overall lack of access for UM Dauvrin - MERH 2018 8

KCE Belgian Health Care Knowledge Center Dominique Roberfroid, Anja Desomer, Cécile Camberlin UCL – Institut de recherche santé et société Marie Dauvrin, Julie Gysen, Vincent Lorant UGent - CCVS-Faculteit Psychologie en Pedagogie & ICRH-Faculteit Geneeskunde en Gezondheidswetenschappen Ilse Derluyn, Ines Keygnaert, Birgit Kerstens Dauvrin - MERH 2018 9