Abstract
• The paper examines access to health care in Costa Rica by Nicaraguan migrants. • It confronts two opposing views - Nicaraguan migrants overuse public health services and they are discriminated • Based on administrative and unique survey data there is no support for either view. • The incidence of migrant health care use is lower than their share in the population. • There is no evidence of systematic discrimination in access to health care against Nicaraguans based on their nationality. As in most immigrant-receiving countries in the global North, countries in the South face challenges regarding migrant access to social rights and the effect of migrants on the sustainability of the welfare state. In the Latin American context, this holds especially for countries such as Costa Rica, which has one of the strongest social policy regimes in the South and the highest (Nicaraguan) immigrant stock in Latin America. Set in the context of Costa Rica, this paper assesses two views which seem hard to reconcile, and, are common in the country. First, it is claimed that Nicaraguan migrants use public health services disproportionately, thereby threatening the country’s welfare system. Second, pro-migrant rights non-governmental organizations and academics are concerned, primarily based on qualitative studies, that access to health services for Nicaraguan immigrants is limited, and that they are discriminated based on nationality. This paper relies on administrative data and a unique data set representative of Nicaraguan born individuals residing in Costa Rica to examine the validity of both these claims. We do not find support for either. The incidence of migrant health care use is lower than their share in the population and at the same time there is no evidence of discrimination in health care access for migrants based on their nationality. The paper underlines the need for more informed migration debates.
Highlights
The incorporation of immigrants in social services is polemic, in most, if not all host countries
Before proceeding it is important to clarify that we restrict our analysis to discrimination in terms of access to health care services and do not deal with other forms of discrimination which may arise when migrants seek health care such as the quality of treatment
On the one hand, this paper assessed whether there is any empirical support for the welfare-magnet claim, namely that immigrants are overrepresented in health services which is the basis for welfare chauvinism sentiments
Summary
The incorporation of immigrants in social services is polemic, in most, if not all host countries. The debate here is on the trade-off between diversity and solidarity, under the assumption that immigration undermines the basis of a comprehensive and solidaristic welfare state (Banting & Kymlicka, 2006; Crepaz, 2016; Facchini, Mayda, & Murard, 2016; Freeman and Mirilovic, 2016; Soroka, Harrel, & Iyengar, 2016; Van Oorschot, 2008) This literature has focused on state reactions to migrant integration in light of growing security concerns in Europe (Caponio & Graziano, 2011; Carmel, 2011; Lahav & Perliger, 2016)
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