Institute of Social and Cultural Anthropology, Freie Universität Berlin, Landoltweg 9-11, 14195 Berlin, Germany.
Soc Sci Med. 2023 Feb;319:115190. doi: 10.1016/j.socscimed.2022.115190. Epub 2022 Jul 8.
European health insurance systems have become increasingly fragmented due to neoliberal health care reforms and the privatization of health care. Attempts to enable transnational access to public health care services throughout the European Union (EU) have contributed to this process by spreading ideas of EU citizens as consumers having to make informed choices about health insurance. However, marginalized populations such as EU migrant sex workers are presented with only limited choices within these systems. This article highlights how these limitations in access to health insurance are not only related to financial precarities, but are also caused by underlying racialized, classist, and sexualized assumptions about citizenship and belonging which influence the legal framework of both national and EU-wide health insurance provision. Based on ethnographic research with migrants from eastern EU countries involved in sex work in Berlin, the article discusses their attempts to gain access to health insurance as a salient example of the moral economy of health insurance provision in a supposedly universal health care system. Following how migrant sex workers from eastern European countries experience and negotiate exclusions from health insurance systems, the article addresses how meanings and interpretations of health insurance change towards an understanding of health insurance not as a right, but as a privilege for those conforming to narrow ideas of European citizenship. This indicates that current restructurings of health insurance systems are not only characterized by increasing privatization. Equally, the (re-)emergence of links between access to health insurance and restrictive ideas of belonging and citizenship rights are undermining aspirations for transnationally available universal health care.
由于新自由主义医疗保健改革和医疗保健私有化，欧洲的健康保险体系变得越来越支离破碎。通过传播欧盟公民作为消费者必须就健康保险做出明智选择的观念，欧盟试图实现整个欧盟范围内公共医疗保健服务的跨国可及性，从而促成了这一进程。然而，像欧盟移民性工作者这样的边缘化人群在这些体系中只能得到有限的选择。本文强调了这些获得健康保险的限制不仅与经济不稳定有关，还与关于公民身份和归属的潜在种族主义、阶级主义和性别歧视假设有关，这些假设影响了国家和欧盟范围内健康保险提供的法律框架。基于对在柏林从事性工作的来自东欧国家的移民进行的民族志研究，本文讨论了他们获得健康保险的尝试，以此为例说明了在据称普遍的医疗保健系统中健康保险提供的道德经济。本文探讨了东欧国家的移民性工作者如何体验和协商被排除在健康保险体系之外，以及他们如何将对健康保险的理解从一种权利转变为对符合欧洲公民狭隘观念的人的一种特权。这表明，当前健康保险体系的重组不仅以日益私有化为特征。同样，（重新）出现的健康保险准入与限制归属感和公民权利观念之间的联系，也破坏了跨国普遍医疗保健的愿望。
