Indicator history

Migrants who are employed have to be included in the mandatory health insurance schemes by law under equal footing with nationals. In cases when health insurance does not arise from employment, different regimes apply to different categories of foreign nationals. Foreign nationals with permanent residency, including refugees, are entitled to compulsory health insurance on equal footing with Slovenian nationals if they meet certain conditions. According to Article 7 of the Health Care and Health Insurance Act, persons with temporary residence or persons without any legal status have limited access to health care services, and have only the right to emergency health care, which includes maintaining vital functions and preventing the deterioration of an individual’s health condition. According to the International Protection Act, asylum seekers shall, in general, have access to emergency health care. In regard to women, this provision also includes contraceptives, abortion and medical care during pregnancy and at giving birth. The law further stipulates that vulnerable groups and exceptionally other applicants have the right to additional medical services if needed. The scope of additional medical services is approved and defined by a commission appointed by the Minister of the Interior (Minister za notranje zadeve). Since 2010, amendments to this law were adopted providing for an equal access with nationals to health care services for minor asylum applicants.

Findings of a research which was based on 22 semi-structured interviews with migrants showed that the migrants face various obstacles in health care, including language barriers and open or hidden discrimination, also based on the lack of knowledge of Slovenian language (Bofulin and Bešter).

Another research based on semi-structured interviews with migrant women showed that migrant women with no health insurance face obstacles when seeking health care assistance, and they may be subject to discrimination, also based on language (Pajnik).

Another research shows similar patterns. It is based on on-going ethnographic research which started in 2008 among ten the migrant workers from Bosnia in construction industry. It showed that they lacked knowledge of the health care system, that they did not take sickness leave for the fear of dismissal, that they faced various obstacles in access to health services and the employers in some cases failed to provide for the migrants' health insurance (Lipovec Čebron).

With regard to the situation of irregular migrants and their access to health services a 2010 PICUM report states that  the most vulnerable group of such migrants includes the persons with mental health issues. There were reports of suicide attempts of the rejected asylum seekers (who consequently became irregular migrants) in the detention centre and asylum seekers in the open facilities. In such cases, the relevant authorities out of fear of media attention, quickly transfer such individuals to the closed mental institutions. The undocumented migrants have only access to the free emergency care (mentioned above). The latter is interpreted very narrowly by the hospitals, and only children are granted more favourable treatment.

In Slovenia there is no comprehensive research on the situation of the Slovenian Roma in the field of healthcare. Available sources generally refer to Roma as a vulnerable group (due to low education level, long time unemployment pattern, and different lifestyle). In this context it was established that Roma face higher incidence of chronic disease and lower participation rates in the preventive programmes, as well as that there is a higher proportion of Roma persons with risk factors for the chronic non-communicable disease.

According to the Social Care Act, migrants with a permanent residence permit have the right to social assistance, child’s benefits as well as all other benefits from the social security under equal footing with nationals of Slovenia.

However, migrants who only have a temporary residence permit only have the right to child benefits. Irregular migrants do not have the right to social protection system.

Access to social assistance and benefits is available to all nationals, regardless of their minority status. However, there are cases of de-facto discrimination on the grounds of ethnicity. The decision of 30 September 2010 issued by the Social Inspectorate (based at the Ministry of Labour, Family and Social Affairs) concerns a Roma couple who inquired about a possibility to acquire municipal financial assistance at the Centre for Social Work. When they inquired about this possibility, the social worker at the Centre responded that this financial assistance is not for Roma. A volunteer of a local association verified by phone whether Roma may apply for this assistance and she also received a negative response: the social worker confirmed that Roma may not apply for this financial assistance.  The social inspectorate found that such treatment constitutes discrimination, as there is no provision in the law that would allow a denial of a certain right on the basis of race or ethnicity. Municipal assistance is available for all people who meet the conditions, regardless of their ethnicity. In the procedure it was establish that if the couple applied for this assistance it would have been granted to them, as they met all the conditions.

Sources:
Bofulin, M. and Bešter, R. (2010) ‘Enako zdravstvo za vse? Imigranti v slovenskem zdravstvenem sistemu’ (Equal health for all? Immigrants in Slovenian health system), in Medvešek, M. and Bešter, R. (eds.), Državljani tretjih držav ali trtjerazredni državljani?, Ljubljana, Inštitut za narodnostna vprašanja, pp. 270-311.

Lipovec Čebron, U. (2010) ‘Slepa pega evropskega zdravstva: analiza nekaterih vidikov zdravja migrantov’ (Blind spot of European healthcare: analysis of some of the aspects of health of migrantzs), in Medica, K. et al (eds.), Migranti v Sloveniji, Koper, Univerza na Primorskem, Znanstveno-raziskovalno središče Koper, Zgodovinsko društvo za južno Primorsko, Univezitetna založba Annales, pp. 57-81.

Pajnik, M. and Bajt, V. (2011) ‘“Third Country” Migrant Workers as “Third Class Non-Citizens” in Slovenia’ in: M. Pajnik and G. Campani (eds.) Precarious Migrant Labour Across Europe, Ljubljana: Mirovni inštitut, pp. 97-118.

PICUM – Platform for International Cooperation on Undocumented Migrants (2010) Undocumented migrants’ health needs and strategies to access health care in 17 EU countries: Country report Slovenia, Brussels, PICUM – Platform for International Cooperation on Undocumented Migrants.

Health promotion strategy and action plan for tackling health inequalities in the Pomurje region, Ministry of Health of the Republic of Slovenia, available at http://ec.europa.eu/health/ph_determinants/socio_economics/documents/slovenia_rd01_en.pdf.

Zakon o socialnem varstvu – uradno prečiščeno besedilo (Social Care Act – official consolidated text), Official Journal of the Republic of Slovenia, No. 3/2007.
Social Inspectorate, Ministry of Labour, Family and Social Affairs, decision no. 06185-148/2010 of 30 September 2010.

In its 2012 Annual report, covering developments in the year 2011, the Human Rights Ombudsman states that the institution was informed about the issue of low vaccination coverage of the Roma children in Novo mesto administrative unit. It found that the Ministry of Labour, Family and Social Affairs notified all Social work centres in the country that they may include the obligation of mandatory vaccination of children in the contracts on active solving of individual’s social issues which they sign with recipients of social assistance. These contracts, governed by the Social Security Act, include obligations which must be respected by recipients of social assistance. If the latter fail to meet the contract obligations, they may lose the assistance. Upon observing the facts of the case, the Ombudsman established that, if not explicitly stipulated in the Social Security Act, the provision of social assistance to an individual might not be conditioned by fulfilment of obligations the individual had under other sectoral acts, which was, in this case, the legislation governing preventive measures against infectious diseases. The Ombudsman further established that such a solution, as proposed by the ministry, might result in unequal treatment of persons based on their social status. Wealthier individuals would only be fined if they failed to respect the provisions of compulsory vaccination, while the socially disadvantaged might be punished twice, with a fine and deprivation of financial assistance. According to the Ombudsman, it was not irrelevant that the observed issue was related to the Roma population, which could also gave rise to concerns about possible discrimination on the basis of ethnic origin.

There were two surveys identified providing insight into the Roma health situation. Both were carried out, in the past, by the Institute of Public Health Murska Sobota.

The results of the first survey (Risk factors for non-communicable diseases in adult population of the Roma community) have not been available for years. Some of the findings were recently published in a publication on the health situation of Roma which aimed at general public and presented available information in rather popular manner. The survey included 259 randomly selected members of Roma communities in Pomurje region between 25 and 65 years of age. It was carried out in 2006 and 2007 using the same methodology as the similar survey carried out at national level. The survey findings showed that more than the half of respondents assessed their care for their health as good or very good. However, almost a third of Roma respondents claimed that their health status was poor or very poor.  
 
 

According to the survey, Roma often suffer from stress which is particularly faced by women, elderly and those members of the Roma community with the lowest educational achievement. As the cause of stress, the respondents cited poor financial situation, problems in the family and loneliness. The survey further showed that smokers form a substantial group in Roma communities (two-thirds of men and half of women). Many of them smoke in living quarters exposing all household members, including children and elderly, to second-hand smoking. In Roma communities, smoking tends to be the most common risk factor for their health status. Daily physical activities are insufficient, particularly among women, while their nutrition habits also tend to be problematic. According to the survey findings, risk factors can be found more frequently among poorer and less educated Roma. The respondents most often reported diseases and malfunctions of the spine and joints as well as lung diseases such as chronic bronchitis and asthma. Cardiovascular diseases and diabetes are the next most common type of health problems faced by the Roma.

The second survey, carried out in 2008 and 2009, was designed to assess the use of healthcare services by Roma women in Pomurje region as well as other parts of the country. It captured 326 Roma women between 15 and 64 years of age. They were mothers of 119 children up to five years old. The research was based on field survey, observation with participation, field diaries, and additional three focus groups discussions were held, two with the Roma women and one with nurses in regular contact with the Roma women. The research findings showed that:

- about 95% of women in all areas were included in basic health insurance scheme, but it also showed that 74.2% of respondents in Pomurje and 69% in other areas had complementary health insurance,

- 97.4% of the respondents in Pomurje have a selected physician, while their share in other parts of the country is 91.4%, while the share of women with a selected gynaecologist is considerably lower, 77.6% in Pomurje and 75.9% elsewhere, and only 33% aged up to 18 years,

- 38.2% of respondents in Pomurje assessed their health state as good or very good, compared to 27.5 % in other areas, while the share of women assessing their health state as bad or very bad was 25.5 % in Pomurje and 27.5 % in other areas,

- some 40% of all respondents reported chest pains during physical activities, 70% reported back, neck and joint pains, 45% of all Roma women reported persistent coughing fits, while 50% reported sleeplessness,

- in Pomurje, 37.7% of women reported depression, compared to 55.2% elsewhere, while 73.2% of women in Pomurje and 60.3% of respondents in other parts of the country reported taking some medications in the last week (no further explanations available; probably a week before the survey or in the week of the survey; our comment),

- some 91% of the Roma respondents in Pomurje claimed that they received the medical assistance on an equal footing with non-Roma women, compared to 74.2% in other parts of the country,

- 96.4% of Pomurje respondents stated that Roma and non-Roma children had equal access to doctors, compared to 76.5% in other areas,

- 97.6% of Pomurje respondents agreed that healthcare workers respectfully treated Roma mothers and children, compared to 77.1% elsewhere.

Sources:

• Slovenia, Human Rights Ombudsman (Varuh človekovih pravic) (2012), Letno poročilo Varuha človekovih pravic Republike Slovenije za leto 2011, Ljubljana, Varuh človekovih pravic, p. 307, available at: www.varuh-rs.si/fileadmin/user_upload/pdf/lp/Letno_porocilo_Varuha_za_leto_2011.pdf.
• Belović, B. (2011), ´Health-related lifestyle of Roma` in Belović, B., Krajnc Nikolić, T. (eds.), Determinants affecting the health of Roma in Pomurje, Murska Sobota, Zavod za zdravstveno varstvo Murska Sobota, pp. 74-76 (bilingual edition), available at: www.zzv-ms.si/si/neenakosti/zdravjeRomov.pdf.pdf.
• Zavod za zdravstveno varstvo Murska Sobota (year of publication not known, the project carried out in 2008 and 2009) Ocena rabe zdravstvenih storitev v populaciji romskih žensk in otrok v Sloveniji – Prispevek k zmanjševanju neenakosti v zdravju, Murska Sobota, Zavod za zdravstveno varstvo Murska Sobota, available at: www.dlib.si/stream/URN:NBN:SI:DOC-WG7BOOBP/2d247d08-9e35-4976-ab38-bf5a813d55a0/PDF.