Healthcare is a basic human right. Since April of this year, the legislation which governs newly-recognised refugees’ access to health insurance numbers has changed, adding to the existing barriers they face to accessing healthcare. This article explains this change and its implications. It is detrimental to the individuals affected by the change in the law and to the Greek healthcare system, because this population will have higher support needs when they can eventually access healthcare again.
The context
Asylum applicants in Greece are issued with a temporary health insurance number (PAAYPA), so that whilst in the asylum procedure, they are able to visit hospitals, health centres and access medication. If their asylum claim is accepted, their PAAYPA number, valid for the duration of the asylum procedure, is converted into an AMKA, which grants permanent access to public healthcare. Until April 2024, upon receiving their residence permit, refugees could go to a Citizen’s Service Centre without an appointment and request the conversion from PAAYPA to AMKA. The new document was issued immediately and the permanent insurance was activated. The new legislation has changed this, increasing the barriers recognised refugees face to accessing healthcare. To convert PAAYPA to AMKA, it is now necessary to arrange an appointment at the Greek social security offices (EFKA). Furthermore, the process itself has become more complicated; individuals must now present two additional documents to convert their PAAYPA to AMKA: proof of address and a job contract.
The barriers
Even before this change, newly-recognised refugees faced barriers to healthcare. These continue under the new legislation. Firstly, one month a positive asylum decision is granted, the PAAYPA number is cut and the AMKA can’t be activated until the new residence permit has been issued. It’s not uncommon for it to take months to be ready, leaving people without access to healthcare while they wait. Rather than addressing and resolving this issue, the new legislation has further complicated things; now an appointment at EFKA is needed, as well as additional documentation.
One of the extra documents now needed is a house contract, which begs the question – what if you don’t have one? Theoretically, people who are homeless have the same access to healthcare as the housed. As an alternative to a house contract, they can provide a certificate from the municipality or the night shelter they use as a proof of address. People who are staying in organisations can provide a certificate from the organisation. Ιf someone is accommodated in someone else’s home, they can submit a certificate of hosting. Practically speaking, however, this requirement represents another hurdle for people who are experiencing homelessness or unstable housing to overcome.
Even if someone does understand the process and manages to make an appointment, they may wait months for it to come around. Converting PAAYPA to AMKA must be arranged in your local EFKA office, not in another neighbourhood. The offices in the most populated areas are currently facing a backlog up to 2 months; during this time, newly recognised refugees don’t have access to healthcare. In addition, many employees have not been trained to implement the new system. As they are getting to grips with the new 59-page legislation, appointments are a challenge for both employees and service users. Τhe outcome of an appointment depends to a large extent on the willingness of undertrained administrators to support people to understand the papers required and how they can move on with their request.
Executing this process, for both housed and homeless refugees, is almost impossible without support from a social worker, accountant and maybe an interpreter, none of which are provided by EFKA. How many people who have recently arrived in a new country can access the information to understand which papers they need, especially if they don’t speak Greek or English and are living on the street? How easy is it to request these documents from the social services? Not to mention the effect of this on refugees who have just turned 18 and been evicted from their minors’ shelter. This clearly shows that access to healthcare is unequal in Greece – refugees must overcome more barriers than the rest of the population to access the same support.
The impact
In practice, this leads to confusion about what is happening and what documents are needed, to extra appointments due to incomplete applications, and, ultimately and most importantly, to more time without access to healthcare, a basic human right. Even before the change in legislation, newly-recognised refugees faced a period of months where they didn’t have access to healthcare while they waited for their new documents to be issued. Now, in addition to this, they must wait for their social security appointment. The first appointment is often unsuccessful since the process is now more complicated and information about how to navigate it is inaccessible, so people wait again for a second or even third opportunity. People who have experienced displacement are a medically vulnerable group. Long periods without healthcare are not only dangerous for them, but also increase the burden on an already-overwhelmed healthcare system in the long-term.
Written by Lara Stauss and Orsalia Papadimitriou