Different systems, similar responses: Recent policy reforms on asylum seekers’ and refugees’ access to health care in Germany and Sweden

Who has – and who deserves – full or partial access to a state’s health-care system? – This question has become an issue of controversial political debate in many countries, not least in the context of recent crises such as the COVID-19 pandemic, and previously the so-called ‘migration crisis’ of 2015-17. This paper focuses on the latter crisis and its repercussions on the political regulation of health-care access for a group at the very margin of society: asylum seekers and refugees. By analysing recent asylum and health policy reforms in two main recipient countries in the EU, this paper sheds light on the increasing politicisation of the area of health policy. Specifically, this paper studies recent developments in the political regulation of refugees’ and asylum seekers’ access to health care in Germany and Sweden – two countries which stood out in various ways during the ‘migration crisis’. Namely, both countries underwent similar processes of initial demonstrative openness to incoming refugees, presenting themselves as ‘moral superpowers’ in comparison to other European countries, and taking in high numbers of people, but later changing their stance towards refugees and asylum seekers under the impression of growing anxiety vis-à-vis those seeking shelter in Europe. These similar reactions are particularly remarkable considering the fundamental systemic differences between Sweden’s and Germany’s incorporation, welfare and health-care regimes. Importantly, this research does not merely take into consideration the short period immediately after asylum seekers’ arrival in a host country, during which the arriving persons are typically subjected to a series of basic health checks. Instead, the paper seeks to shed light on the process of integrating refugees and asylum seekers into the respective health-care systems beyond such initial checks – which serve as much to document the arriving persons’ health status as to prevent the spread of disease in the host country – and also beyond mere emergency care. Every person, regardless of their nationality, is legally entitled to the latter in all EU member states, based on the fundamental right to health care as laid down in Article 35 of the Charter of Fundamental Rights of the EU. This article does not, however, grant full access to the respective national health-care systems; indeed, national legislators have much room of interpretation when it comes to the regulation of third-country migrants’ rights in the area. The dataset underlying the analysis consists primarily of policy documents such as legislative texts, government declarations, statements by ministries and responsible state agencies, and minutes of plenary debates. In a policy analysis applying the historical-institutionalist concepts of path dependency and critical juncture, this paper demonstrates how and why policy provisions underwent similar changes in Germany and Sweden over the last six years. In so doing, the paper provides evidence for the relevance of different factors in the political regulation of health-care access for asylum seekers and refugees, namely: of short-term changes in numbers of arriving asylum seekers, of national elections and (resulting) party politics, and of EU legislation and EU-level agreements.