Commercial health insurance: a barrier to health care access for non-European Union migrants in the Czech Republic

Abstract

In 2016 there were 493,000 foreigners legally living in the Czech Republic (58% out of this number were non-EU nationals). By law, all migrants staying in the CR on a longterm basis are legally obliged to participate in some health insurance plan throughout their stay.

Migrants may meet this requirement via public or commercial health insurance. Public health insurance is available for all regular migrants permanently residing in the CR and all migrants from the EU.

NonEU migrants are eligible for public health insurance as long as they work in the CR with the status of an employee. All other non-EU migrants are forced to purchase commercial health insurance.

The total number of all these migrants is estimated about 80,000 persons. The objective of the study is to describe commercial health insurance for migrants in the Czech Republic and to explore experiences of migrants and health care providers with that insurance.

Forty-four semi-structured interviews were conducted with 24 non-EU migrants and 20 health care providers. The data were analysed using thematic analysis.

Current Czech legislation provides only a vague framework for commercial health insurance and does not include client protection. The results indicate that commercial health insurance causes many problems.

It poses a considerable financial burden on migrant families with children and undermines access to health services mainly for children, pregnant women and seriously or chronically ill persons. The limited access to health care leads non-EU migrants to use alternative strategies to achieve health (cash payments, postponing treatment and self-medication).

This may result in risks both to them and the host society. In comparison to public health insurance, conditions of commercial health insurance are significantly worse.

Commercial health insurance does not guarantee migrants the necessary health care.