How Germany excludes some EU citizens from healthcare
The German section of Médecins du Monde/Doctors of the World is offering free healthcare and counseling for people with restricted or no access to the healthcare system in Hamburg, Berlin, Stuttgart and Munich. In the past few years, EU citizens – mainly Romanians and Bulgarians – have become the largest group of beneficiaries. Of the 786 new patients in our clinics in Hamburg, Munich and Berlin in 2017, 56.7% were non-German EU citizens.
4.7 million citizens from other EU countries lived in Germany in 2017. While the majority have health insurance through the European Health Insurance Card (EHIC), through a regular job or a working family member, EU nationals from new EU member states (which are not members of the European Convention on Social and Medical Assistance) face major difficulties in accessing healthcare if they do not have regular employment.
A law passed in December 2016 has worsened the situation of several groups of EU citizens. The law excludes unemployed EU nationals from social protection services, including basic healthcare coverage, if they have not been regular residents of Germany for at least five years, if they have no right of residence under EU rules or if their right of residence results solely from the purpose of finding work or from having children in education in Germany (Article 10 of the EU Regulation on the freedom of movement for workers).
For these groups, only so-called ‘bridging benefits’ are provided for a maximum of one month and only once within two years. These benefits include basic health services required for the treatment of acute illnesses and pain. After receiving these reduced benefits for one month, the affected groups have no entitlement to the coverage of any, even emergency, healthcare services for the next 23 months, if they remain unemployed.
The experience of Doctors of the World shows that people stay in Germany, as the situation in the countries of origin is often even worse, but avoid going to the doctor when they are sick. As hospitals are not reimbursed, they are hesitant to treat them. Clinics set up by civil society are therefore the only place where they receive healthcare.
Beyond access to healthcare, the law dangerously impedes the living conditions of many EU citizens, because these groups are also not entitled to benefits, homeless shelters, or other social welfare services.
The exclusion from social services, including healthcare, has led to many critical reactions. In reply to a letter signed by 37 civil society and welfare organisations, the Ministry of Work and Social Affairs said that it considers the health coverage of affected EU citizens sufficient, because in individual cases and in special circumstances healthcare can be covered. Individual case decisions are, however, lengthy and there are no clear criteria on what is covered. In any case, they do not imply an entitlement.
The right to access healthcare is part of the UN international Covenant on Economic, Social and Cultural Rights. Based on the Covenant, it is the duty of the state to ensure non-discriminatory access to healthcare. Thus, under the coordination of Doctors of the World, civil society groups made a submission to the UN Commission on Economic, Social and Cultural Rights (CESCR) on the right to health. The UN Covenant on Economic, Social and Cultural Rights sees access to healthcare as a main responsibility of the state.
A report published last year by Doctors of the World shows that many EU citizens fall through the cracks and struggle to access healthcare in Europe. Of the over 43,000 people we helped across 13 European countries in 2016, 3,257 were nationals of the European Union or the European Economic Area (EEA) living in another country (7.5%). The majority of them were living below the poverty threshold, were unemployed or homeless, or in conditions of social isolation.
While Doctors of the World is providing healthcare for those left without support, this important task cannot and should not lie with voluntary civil society organisations. The principle of free movement and residence of EU citizens should be extended to a right to health. The EU needs a legal framework that ensures access to healthcare for all EU/EEA citizens irrespective of their resident or social security status.
Johanna Offe, Doctors of the World Germany
Doctors of the World is an international human rights organization providing emergency and long-term medical care to vulnerable people, wherever they are.
Photo courtesy Doctors of the World Germany.