The impact of ‘national values’ on health-care provisions for refugees and asylum seekers in Germany and Sweden

Refugees’ and asylum seekers’ access to health care is an important aspect of their mid- to long-term integration into host countries’ societies – or of political endeavours to keep them at the margins of society, based on different conceptions of these persons either as temporary residents, or as future citizens of the host country. Drawing on the concept of ‘national values’ as defined by Marmor et al. (2006), this paper studies the normative dimension of the political regulation of refugees’ and asylum seekers’ access to health care in Germany and Sweden. The paper focuses thus on two countries which stood out in various ways during the recent so-called ‘migration crisis’. Namely, both countries underwent similar processes of initial demonstrative openness to incoming refugees, presenting themselves as ‘moral superpowers’ (Bradby 2019) in comparison to other European countries, and taking in high numbers of people, but later changing their stance towards refugees and asylum seekers under (perceived) pressure through a shift of public opinion. These similar reactions are particularly remarkable considering the fundamental normative and also systemic differences between Sweden’s and Germany’s incorporation, welfare and health-care regimes, concerning e.g. issues of universality and deservingness, and individual preconditions for the utilisation of health and welfare services (Roos 2021; Sainsbury 2012). This paper examines the impact of particular sets of 'national values' on policy changes concerning asylum seekers’ and refugees’ access to health care in Sweden and Germany over the last six years, i.e. starting with the status quo prior to the so-called ‘refugee crisis’. The paper studies the extent to which certain normative understandings of health – e.g. as human right, legal standard, or social benefit – influenced policy provisions for refugees’ and asylum seekers’ health-care access beyond basic checks performed upon arrival in a host country, and emergency care. It also discusses how related policies were shaped by different ‘national values’ and norm-based conceptions of the state’s general role in the provision of health care, and individuals’ claims to and common perceptions of health services e.g. as a benefit which has to be deserved, or as an element of universal protection. ‘National values’ underlying policy changes are traced in related national legislation, and in documents that provide insights into policy-making processes, such as statements by ministries and responsible state agencies. Further sources like parliamentary minutes and election manifestos reveal which norms and values are commonly accepted or contested in the respective countries, and which specific interests underlie the identified policy changes. By juxtaposing, contextualising and comparing this normative dimension of recent changes in Germany’s and Sweden’s respective regulation of asylum seekers’ and refugees’ access to health care, this paper contributes to a better understanding of recent developments in health and migration policy as two areas in which possible solutions to current challenges are hotly debated, and which will presumably retain a dominant position on political agendas for years to come.