Improving access to health care for asylum seekers in Belgium: a national stakeholder consultation

Abstract

Abstract Background All asylum seekers (AS) in Belgium are entitled to health care coverage while awaiting a decision regarding a refugee status. However, in practice, numerous public institutions oversee the governance, the distribution of funding and the practical organisation of health care. As a result, AS have currently no guarantee of receiving the health care they need. Methods In 2017-2019, a 5-step approach was used. Firstly, 3 data sources were combined to identify major problems and possible options to solve it (literature, interviews, and existing databases). Secondly, these options were submitted to a large panel of Belgian experts, field workers and policymakers through an online survey (n = 171). Survey results and non-consensual results were discussed in a 3rd step with 35 field workers, experts, and policymakers. In a 4 step, individual interviews were conducted with stakeholders likely to be affected by the different options. In a final step, all stakeholders attended a final meeting following by an online consultation to validate the final options. Results Stakeholders agreed on 3 basic principles that should sustain a reform of health care for AS: respecting the current legal framework, ensuring equity among all AS and supporting administrative simplification. Three different models of access emerged with 2 options regarding the governance of health care for AS and 3 options for the distribution of the funding. Each model was assessed regarding its impact on the identified problems and the respect of the 3 basic principles. Besides, 8 quick-wins at the system level and 6 at the organisation level were proposed. Conclusions Despite the involvement of the policymakers, no consensus was found at the end of the research. Final decision will then remain in the hands of the policymakers. Key messages In Belgium, access to health care for asylum seekers is impeded by the numerous public institutions involved. Equity between asylum seekers should be guaranteed by an appropriate governance and an adequate distribution of funding.