Bound between care and control: Institutional contradictions and daily practices of healthcare for migrants in an irregular situation in Italy

ABSTRACT

On the books, the inclusiveness of the Italian framework regulating healthcare access for migrants is indisputable. However, we might wonder how access takes shape on the front-line of the healthcare system, particularly in times of increasingly hostile institutional and discursive environments. By focusing on Italian migration and healthcare policies and the practices of health workers during their encounters with migrants in an irregular situation, this contribution analyses how health workers deal with institutional tensions in the field and how these, in turn, shape their narratives and actions. It suggests that individual positioning plays a major role in favouring the adoption of discretional practices of care or control. Nonetheless, practices are also mediated by the wider institutional and discursive landscape, which has been exponentially characterized by a tension between a medical-humanitarian logic that legitimates providing healthcare to vulnerable migrants, and a control-oriented logic targeting immigration and health expenditure.

KEYWORDS:

• Migration
• healthcare
• institutions
• street-level bureaucrats
• hostile environments
• Italy

Acknowledgements

The author would like to thank the three referees for their very useful suggestions, and Jean-Michel Lafleur and Teresa M. Cappiali for helpful feedback on the preliminary draft of the article.

Disclosure statement

No potential conflict of interest was reported by the author.

ORCID

Roberta Perna http://orcid.org/0000-0001-6700-1997

Notes

1 Coverage includes health services that are urgent (cannot be deferred without putting the patient's life at risk), or essential (preventative and curative). Care must be provided on a continuous basis, meaning until the treatment and rehabilitation cycle is completed.

2 When analysing ethnic boundary-making in health policies after the 2010 Affordable Care Act in the US, Marrow and Joseph (2015) define “boundary expansion” as the process through which new people have been included in a group they were previously excluded from (referring to the healthcare insured group), such as racial minorities and poor Americans.

3 Estimates concerning the presence of migrants in an irregular situation are not available on a regional level. Therefore, data refers to the foreign resident population.

4 Interestingly, these racially marked groups are the ones that have been affected the most by discourses of race and criminalization in Italy since the mid-1990s (Angel-Ajani 2003; Kosic and Phalet 2006).