Is it a scandal that around 8 million Roma fall just outside the healthcare system? : A qualitative study exploring access to the health insurance and health care for Roma staying in Sweden

Abstract: Introduction: The Roma is the largest ethnic minority in Europe, estimated to be over 11 million (1.35% of Europe’s total population). At the same time, it is the most vulnerable and marginalized community, facing many challenges in everyday life, such as low levels of education, unemployment, poverty, limited access to information, social and health services as well as racial discrimination. Roma people have great health needs and lack access to the European Health Insurance scheme. Efforts by governments across Europe to address these health inequities have been relatively weak and Roma suffer poorer access to health care, health insurance, education and employment in every country that they inhabit in comparison to the majority population. There are studies exploring the health situation of the Roma, but very limited information is available about the availability of the European Health Insurance for Roma and access to health care in Sweden. The general aim of this study is to explore access to the health insurance and health care for Roma staying in Sweden. Methods: A qualitative design methodology has been applied in this thesis. Four non-government organizations in Sweden were contacted and six in-depth interviews were done with professionals and volunteers from those organizations. Questions were asked about experience of working/volunteering and assisting Roma people in accessing health care in Sweden. The interviews also addressed barriers faced by Roma to obtain the European Health Insurance in Romania. The data was analyzed using inductive thematic analysis. Results: Four themes were developed during the data analysis. The first theme “A bureaucratic and unfriendly system makes it hard for Roma to get insured in Romania” is about the role of the Romanian government in maintaining the (disadvantaged) situation of Roma people. The second theme “Difficult to access the health care services in Sweden, without active European Health Insurance” explains the situation of Roma people, when they seek medical care in Sweden and the importance of having an active European Health Insurance. The third theme “European Union policies do not respond to the health care needs of Roma” elaborates on the governance of the whole health insurance scheme from the EU level and how it is not designed to fit the needs of the Roma. The fourth theme “The history of racism and discrimination of Roma is the root of this situation” is about how society perceives Roma people and how they have been treated for a long time as slaves, with labels including discrimination and racism. Conclusion: This study highlights that access to health care for Romanian Roma people staying in Sweden cannot be seen as a separate issue from that of the situation of access to the health insurance scheme - the National Health Insurance and the European Health Insurance - for Roma in Romania. The study highlights that access to health care and the European Health Insurance for Roma in Romania is often determined by the (dis)functionality of the health system in Romania, corruption and bureaucracy. Without an active European Health Insurance, Roma cannot access health care in Sweden. As an additional burden, they are requested to prove that they can access health care as undocumented people. European Union regulations and laws make it difficult for people who do not have official work to obtain European Health Insurance. The history of racism and discrimination is, potentially the root of the situation. Even today Roma are judged with prejudices, stereotypes and pre-existing beliefs that makes access the health insurance and health care for Roma staying in Sweden even more difficult.