ZurichHealthcare for undocumented migrants
What is inspiring?
In Zurich, people have been looking for ways to provide healthcare services to people without documents and to help them resolve their residence status. The city has announced it is going to strengthen existing institutional structures so that they benefit all people whose main place of residence is Zurich but who do not have healthcare insurance – including sex workers or people without housing. The local government estimates however that the main group in need of this is undocumented migrants, and this will continue to be the case. The project is modelled on the Geneva-based project CAMSCO (“Consultations Ambulatoires Mobiles des Soins Commmunautaires” / “Community mobile outpatient consultation hours”). This service has proven itself to be particularly important during the pandemic for being able to offer undocumented migrants the chance to get vaccinated.
What was the challenge until now?
Until now, medical care for undocumented migrants was largely covered by the contact point for undocumented migrants SPAZ (Sans-Papiers Anlaufstelle Zürich) and the “Meditrina” of the Swiss Red Cross unit for the Canton of Zurich. The problem with this system was that in order to obtain health insurance, a billing address was needed. Many undocumented migrants feared that this would lead to them being deported and thus avoided taking out health insurance. In addition, most undocumented migrants do not have the financial means to pay for healthcare insurance, which in Switzerland costs between 300 and 2.500 Swiss francs per person per month. As a result, the council estimates that a mere 5% of undocumented migrants living in Zurich are insured. The rest, according to the council, are dependent on free options provided by charities and are “definitely medically underserved”.
How does the service work?
Zurich has established a three-stage care structure. Initially, the persons seeking help approach “Meditrina”. The centre will receive an initial sum of around 470,000 Swiss Francs per year until the end of the pilot phase in 2023. In return it offers consultation hours for 6 hours a day that will enable people to access free basic medical care. In cases where a more specialised medical examination is needed, the centre refers the undocumented migrants to a public hospital as a second step. To this end, the two public hospitals Waid and Triemli have been officially appointed as “treatment hospitals for undocumented migrants whose main place of residence is Zurich”. In this second stage, diagnostic tests and treatment are provided, both of which are covered by the Swiss Federal Law on Health Insurance. Undocumented migrants have to cover 10% of the costs themselves, to a maximum amount of 1,000 Swiss francs a year. In the third step: if a patient needs to be admitted to hospital, then they are registered with a statutory health insurance scheme and the federal and local government share the cost of the insurance contribution. In cases where it does not make sense to register with a health insurance scheme, because the costs remain within the personal contribution limit but these cannot be paid by the patient, then the local council steps in and pays. For these three care stages, an initial sum of 1.5 million Swiss francs per year have been set aside.
Who initiated the project? How?
In 2020, following three years of preparatory and campaign work by organisations including the SPAZ, the local council of Zurich commissioned a pilot project aimed at providing healthcare to undocumented migrants without regular health insurance. As is declared in the local council’s resolution, even if the undocumented residents “have an ongoing administrative dispute with the authorities”, the state has a duty of care for these people under international law. The council acts under the assumption that the so-called universal compulsory coverage provided under the Swiss Federal Law on Health Insurance also applies to people who officially are not allowed to be in the country. This means they are eligible to medical care in cases of illness, injury and pregnancy / birth.