Immigrants in italy and their right to health services: the importance of health services for an easier integration
| Author | Monica de Angelis |
| Position | Universita Politecnica Delle Marche Ancona, Italia |
| Pages | 145-154 |
Page 145
Migration from economically and socially underprivileged countries is a global phenomenon that registers millions of immigrants in many parts of Europe. In Italy, where there is no strong tradition of immigration, unlike countries such as France, England and Belgium, the problem of immigration has taken on significant proportions only after the 80s. There have been some closely linked factors leading to an increase in the presence of immigrants in Italy: geographical location, with extensive boundaries, in an area that has strong migratory pressure (close to the continents of Africa and Asia); a flow plan that is quantitatively weak and operationally ineffective, a phase of economic recession and of restrictive policies activated by Central-North European countries that are directed towards shifting the flow of immigrants towards the European countries in the Mediterranean region [2].
In the past ten years, in subsequent attempts, a necessary regulatory framework concerning immigration has been brought to perfection in Italy. However, this framework does not seem to be quite clear and defined and does not help the current circumstances as it states that even other European countries do not have a specific and satisfactory legal framework. Perhaps, even for this reason, in a report on the health conditions of immigrants in Europe and in a recent essay published by Eurohealth, it was underlined how little is known about the access to health services by 35-40 million foreigners living in Europe [3]. In all member States, immigrants are identified as subjects that risk poverty and social exclusion, but despite this knowledge, no country is able to provide a sufficiently detailed analysis of the factors that lead to these conditions. Page 146If health is a useful indicator to better understand the willingness to accommodate and to the degree of social integration that a member state can offer, in that case it is worth indicating the poor attention that Europe pays to the political policies for immigrants. It is a disregard that today is considered unacceptable from a European integration as well as from a human rights perspective. One must not forget that the phenomenon of migration, though controlled (more or less restrictively, keeping in mind all the political, social and economic elements related to each country), brings along with it social and cultural needs which institutions at every level have to face with adequate measures of social inclusion in different sectors and above all in the health sector [4]. Hence the rise in an interest in integration policies and especially in the legal framework which represents the starting point of every serious and long lasting system for receiving immigrants.
Regarding immigrants' access to health services, only in 1998 was the total right to health provided to foreigners in Italy in two respects, as in art.32 of the Constitution, which states it as a fundamental right and of interest to society. The constitutional vision entails that the right to health cannot be limited to citizenship and that all those living on national territory have to be guaranteed the best health care in the safeguard of public health. Constitutional jurisprudence has always acted upon these lines which also states that health care has the role of public service and it refers to a subject's total and unconditional right: and as such, citizenship has no relevance to a user of the national healthcare system. Precise regulations, regarding procedures for foreigners to access the services provided by the National Health Service can be found in Law no. 40 of 1998 which has been merged with the Unified Body of law on immigration [5] and with the subsequent implementation act (Presidential Decree no. 394/99): immigrants, who have regular permits are included in the healthcare services with full rights which are at par with those of the Italian citizens. A part of these measures are likewise extended to those who are present in Italy without legal stay permits or are clandestine depending on the rules summarized later.
The present healthcare framework for foreigners is in the form of a package of measures that have been diversified according to the foreigner's status. Depending on the above-mentioned Implementation Rule, it is best to distinguish above all measures for foreign citizens belonging to the European Community, and among these it is worth pointing out the services provided to European citizens who are legally resident in Italy. Foreigners having European Union citizenship and who are legally residing in Italy are obligatorily registered with the NHS and are at par with Italian citizens. Registration with the NHS gives the right to freely choose a family doctor or paediatrician; to specialist treatment prescribed by family doctor or paediatrician (but unnecessary for dentistry, gynaecology and obstetrics, paediatrics and ophthalmology) paying, where required, a prescription charge; normal admission and day hospital; pharmaceutical drug assistance (for purchasing medicines). Registration is made at the Local Health Authority (basic public health offices, LHA) where the subject is resident and covers the entire time period of the residence permit or card for the holder and his or her family [16]. Special regulations also exist for thePage 147 so-called brief stay period: the European Union citizens can directly access health services by showing their "European health insurance card" [7].
Then, there is a category of foreigners who do not belong to the European Union and, stateless people. Among these there are foreigners who have regular stay permits and have requested renewal of their stay permits (art. 34 TU) [8]. They have the obligation/right to register with the NHS and are at par with Italian citizens as regards healthcare provided by the NHS (including assistance to their families legally settled in Italy) when they find themselves in the following situations: self employment, subordinate employment, enrolled on the unemployment list, family motives and family reuniting, political asylum, humanitarian asylum [9]; request for both political and humanitarian asylum [10]; awaiting adoption, in foster care and purchasing citizenship and health problems [11].
As regards providing healthcare to foreign prisoners, regulation no. 230 of Decree 22/6/1999 is in force, which states that all foreign prisoners (legal or clandestine) under part-time detention or those are undergoing alternative measures to their sentences, be registered with the NHS during their detention period. They are at par in terms of rights with free citizens and are exempt from paying the prescription charge.
The current regulation in force likewise provides for a voluntary registration scheme with the NHS. This registration can be requested by: 1. on payment foreigners with legal stay permits having a duration of more...
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