State, citizenship and health policy in an age of global mobility: A comparative study of Germany and Israel

Background: Migration is a worldwide phenomenon in our globalized world. Depending on immigration and social policies of the host country, migrants' access to civil and social rights varies widely, leading to situations in which individuals or groups have established de facto long-term residence in a country, yet remaining completely excluded from national social and health schemes. The present research is a comparative study of migrants' access to healthcare in Germany and Israel. We choose Israel and Germany as they have in common a) large migrant populations, b) exclusive conceptualizations of citizenship entrenched in their definitions of citizenship, and c) commitments to universal health coverage, which are, however, applied differently: Israeli legislation links health entitlements to residency status, while Germany uses an employment-based insurance scheme that is theoretically independent of legal status.

Methods: The research combines policy/ institutional analysis, qualitative data from interviews with key informants – policy makers, healthcare providers, NGO activists, migrants - as well as statistical healthcare information that is compiled by a NGO-run clinic for uninsured persons in Tel Aviv/ Israel.

Results: The present research provides a deeper understanding of the rationales that underlie immigration and health regimes in the Israeli and German contexts. It analyses conflicting rationales – the logic of the market, of human rights, of public health, of ethno-national conceptualizations of citizenship and belonging – that frame migrants' access to healthcare; and it identifies contradictions and loopholes caused by the dynamic interaction between these rationales, such as on the national-local and the policy-practice interface.