State, Citizenship and Health in an Age of Global Mobility: A Comparative Study of Labor Migrants' Health Rights in Germany and Israel
Author: Gottlieb, Nora D, die.rote.nora@gmail.com
Department: Health System Management, Politics and Government
University: Ben-Gurion University of the Negev, Israel
Supervisor: Nadav Davidovitch, Dani Filc
Year of completion: 2012
Language of dissertation: English
Keywords:
citizenship
, comparative research
, health rights
, migration
Areas of Research:
Health
, Migration
, Poverty, Social Welfare and Social Policy
Abstract
Background: The effects of globalization and migration on countries worldwide cannot be overestimated: they pose distinctive challenges to liberal welfare states. Health policies towards labor migrants reify tensions between universalistic and closed national concepts of citizenship and rights. This study investigates the rationales underlying states' policy choices concerning labor migrants' entitlement to publicly funded healthcare. Germany and Israel serve as test-cases, having in common a) large labor migrant populations, b) exclusionary conceptualizations of citizenship, and c) a commitment to universal health coverage. This comparative analysis of the respective decision-making processes thus offers a showcase for the development of social citizenship in an era of migration.
Goals: This study aims to a) illuminate the rationality of states' health policies towards documented and undocumented labor migrants, and b) to contribute to a better understanding of the meaning of citizenship in an age of globalization.
Methods: This study employs mixed-methods, including 1. qualitative analysis a) of relevant policy documents, and b) of 71 in-depth interviews with policy-makers and labor migrants in Germany and Israel; and 2. quantitative analysis of socio-demographic and healthcare-related data that were retrieved from walk-in clinics in Berlin and Tel Aviv-Yafo, as well as an economic assessment of Israel's current labor migrant healthcare scheme.
Results: In Germany, documented labor migrants enjoy formal health entitlements equal to citizens; by contrast, undocumented migrants' access to care is severely restricted. In Israel, all labor migrants remain excluded from the national healthcare scheme. The study shows that both states' health policies towards labor migrants are shaped by an interplay of divergent rationales such as the logic of the labor market, public health, health economy, immigration control, professional ethics, and human rights. Its findings indicate that granting universal access to basic primary healthcare offers a range of advantages. Nonetheless, both states maintain the exclusions described above. The respective policy decisions are rationalized by context-specific 'discourses of deservingness' which interweave evidence- and value-based arguments. German policy-makers justify restrictions on undocumented migrants' healthcare access with the social contract's tenets of solidarity, reciprocity and rule of law, and with undocumented migrants' violations thereof. By comparison, the Israeli narrative centers on ethno-cultural belonging as prerequisite for membership in the national healthcare scheme. Concerns over waning welfare resources shape policies towards labor migrants in both settings. Finally, the study illustrates that, rather than clear-cut in-/exclusion, policies in Germany and Israel produce various forms of partial membership and health rights, which affect migrant- and to an increasing extent also citizen-populations.
Conclusions: This study elucidates how differences between German and Israeli labor migrant health policies are related to contrasting conceptualizations of citizenship. The German emphasis on abidance by the rules of the social contract reflects a moral economy-framework of rights whereas an ethno-national citizenship-concept dominates Israeli policies. Furthermore, the study points to the pervasive effects of welfare states' neoliberal reconfiguration, which compromises migrants' and citizens' social rights and security alike. Taken together, these insights suggest that the restricted health rights of certain labor migrant populations in both countries may herald the erosion of social citizenship from the margins rather than its incremental post-national expansion.
