Access to Health Care for 'Illegal EU Migrants' in Times of Crisis: Selective Inclusion and Hierarchies of Health-Related Deservingness in Italy and Spain

The definition of intra-EU mobility has been accompanied by increasing coordination in the field of social protection across the EU, notably in the domain of health care. Although Regulation 884/2004 guarantees equal access to health care for employed or self-sufficient EU citizens, some Member States broadened eligibility criteria over time to include the inactive and (legally) unemployed ones, reflecting countries’ specific health care and migration traditions. In times of economic downturn and increasing concerns about welfare tourism, however, restrictions in access to health care have been debated and even introduced against those mobile EU citizens who have been increasingly perceived as a burden on the national welfare system. By focusing on policies and practices regulating access to health care for uninsured EU citizens in the Italian and Spanish universalistic health care systems, this study explores the ways in which health-related deservingness of mobile EU citizens has been (re)defined in times of crisis. It suggests that, in these countries, wide access to health care for uninsured EU citizens reflected different universalistic health care traditions, as well as preferences for particular patterns of (employment-related) mobility. Within the frame of the economic crisis and the need to confront “health tourism”, however, both countries introduced restrictions in eligibility criteria together with complex procedural requirements largely affecting uninsured EU citizens, converging in their procedures regulating EU citizens’ access to health care to exclude the undeserving “illegal EU migrants” from the realm of social citizenship.