Immigrants' access to healthcare: the case of Italy

1 1. Introduction The empirical analysis of inequities in healthcare’s access is quite challenging due to the set of demographics, socioeconomic, territorial and cultural factors which are context-specific and which influence the individual’s health needs and demand for healthcare. Inequities exist if there are systematic variations in access to healthcare that are unrelated to health needs and that are beyond individual’s control (Devillanova and Frattini, 2016). Ensuring equitable access to healthcare has been largely recognized by governing institutions around the world as the main tool to reduce health disparities. The European Union’s legislation partially addresses the issue: it provides protection against discrimination in access to healthcare on the grounds of “racial, ethnic origin and sex” (Directive 2000/43/EC 1 and Directive 2004/113/EC 2 ), but it ignores other individual characteristics such as religion, belief or sexual orientation. Directive 2011/24/EU 3 protects against discrimination on grounds of nationality, but it refers only to nationality of patients originating from other Member States. Moreover, the Treaties assign to the Member states the responsibilities for the organization and delivery of health services and medical care, leaving the issue of equity of access to healthcare disharmonized and largely dependent on national regulations (Orzechowski et al., 2020). In the Italian legislation, the Constitution recognizes health protection as an inviolable right and guarantees it to all individuals, regardless of their individual characteristics and citizenship. 4 Interestingly, the Legislative Decree 286/98 5 made Italy the first in Europe to address migrants’ health and access to health services through specific policies (Listorti et al., 2022). Nevertheless, as the empirical evidence suggests, migrants still face a lot of barriers in accessing 1 European Union. Council Directive 2000/43/EC of 29 June 2000 implementing the principle of equal treatment between persons irrespective of racial or ethnic origin. Official Journal of the European Union L180. 2000. 2 European Union. Council Directive 2004/113/EC of 13 December 2004 implementing the principle of equal treatment between men and women in the access to and supply of goods and services. Official Journal of the European Union L373. 2004. 3 European Union. Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. Official Journal of the European Union L88. 2011. 4 Costituzione della Repubblica Italiana, Parte I, Titolo II, Art 32, comma 1. 5 National Legislative Bodies. Legislative Decree 286/98, art. 35, Paragraph 3. National Legislative Bodies; Rome, 1998.