2.10-P10Cost savings through timely treatment for irregular migrants and European Union citizens without insurance

Abstract

preventable costs for society. Europe needs immigrants in order to ensure future productivity and welfare-and there are very good reasons to ensure the best possible health of the migrants right from their arrival in Europe. Migrant health: putting the economic argument into the context of deservingness debates The main arguments for improving access to health care for marginalised groups, including migrants and ethnic minorities, have mostly been based on public health considerations, human rights claims and ethical principles of equity. However, the respective political debates often focus on economic arguments such as moral hazard, (presumed) health expenses, and the need to safeguard scarce resources. Acknowledging the role of economic arguments in political decision-making processes, researchers and activists have begun to pay more attention to the fiscal implications of limiting migrants' access to care. As yet, however, empirical evidence on the economic implications of different policy responses to migration is scarce. As pointed out by Trummer and Krasnik, 1 the 'right to health care is acknowledged in many international declarations-however.. . only a few countries have adopted national policies on migrant and ethnic minority health to meet the challenges.' They also cite several recent studies indicating that restricting access to care for those groups does not help save costs. While we absolutely support the call for evidence of the economic consequences of exclusionary policies, we also want to point out the need for a better understanding of how economic arguments have been put forward within different contexts, and how such evidence can actually be moved into practice. According to our and others' research, 2,3 economic arguments are perceived and employed very differently in different contexts and in interrelation with a variety of other rationales. Considering the central role of economic arguments in political decision-making generally, and considering furthermore the concurrent context of austerity specifically, one would expect that the costs of migrants' exclusion will leave an impact on the political debate-all the more since they are corroborated by empirical evidence. Yet, in our experience economic arguments in support of migrants' greater inclusion gain only scant attention; and suggestions for inclusive policy reforms continue to be regarded as impractical romanticism. More than that, the economic argument that, in an integrated health care scheme, migrants' health needs would become a drain on the system continues to be used to justify exclu-sionary policies, although no empirical data is produced in order to verify it. In light of the evidence mentioned above the decision to maintain restrictions on migrants' health entitlements seems self-defeating. Why not opt for a more inclusive alternative to resolve the tensions with international law and agreed-on ethical principles and, in the same breath, enjoy the economic (and public health) benefits of such policy reform? What are the reasons, really, that keep governments around the world from making such change? In our view, what ultimately tips the scales in decision-making processes on migrants' health entitlements are value-based, rather than evidence-based rationales; namely, discourses of deservingness. '[A]rticulated in a vernacular moral register that is situationally specific and context-dependent' 4 these discourses demarcate right-holders from non-right-holders. Importantly, 'deservingness debates often have less to do with empirical evidence than with.. . everyday responses to normative questions. These vernacular responses generally mix subjective attitudes and presumptions with taken-for-granted truths regarded as collective ''common sense.''' (ibid.) Moreover, these moral discourses are very different from universal-istic human rights and public health ethical frameworks in that they absolutely discriminate; e.g. on the basis of national belonging or perceived contribution to society. Are we arguing that these deservingness discourses are powerful enough to simply override all other factual and ethical arguments for migrants' greater inclusion? Not exactly. The interaction between discourses of deservingness and other rationales is not straightforward in that evidence-and value-based arguments, knowledge and norms, 'facts' and 'politics' are interweaved in dialectic manners: not only do empirical facts influence the formation of normative positions; but also normative positions mold the generation and perception of factual 'knowledge', including in the field of health and evidence-based medicine. 5 This interaction deserves further research. And more questions remain; e.g. why are discourses of deservingness so rarely invoked to legitimize exclusionary policy choices? What are the reasons that, instead, economic arguments that are unfounded or even belied by evidence are used to uphold exclusionary policies? How can we explain that these arguments persistently dominate the discussions on migrants' access to care? And how can we explain that, by way of comparison, evidence-based arguments in favor of more inclusive policies barely succeed to attract political decision-makers' interest? And finally: what are the consequences for us as researchers, if the influence of scientific evidence on political decision-making processes concerning Viewpoints 591