The Cost of Negligence: Fiscal and public health benefits of investing in refugee healthcare

Abstract

Background: As a result of the global refugee crisis in recent years, policymakers, advocates, and other stakeholders have entered the debate regarding refugee healthcare entitlements. Do states have an obligation to provide comprehensive healthcare to refugees? If so, what effect would refugee integration have on the public health conditions and healthcare expenditures of host countries? These questions have serious implications for the legal and practical implementation of refugee healthcare regimes, which will ultimately drive refugee health outcomes. This thesis investigates these questions through a case study of South Africa, which has the third largest population of refugees and asylum seekers in the world. By better understanding the refugee situation in a middle-income country with a consistent flow of asylum seekers, this analysis can help inform stakeholders in South Africa and beyond. Methods: International treaties and domestic legal documents were consulted to characterize South Africa’s human rights obligations to refugees. UN representatives, public health experts, and care providers in South Africa were interviewed to investigate how these obligations were being met. To estimate the effects of improving refugees’ access to the healthcare system, disease modeling for an illustrative disease, HIV, was conducted in the UNAIDS-sponsored AIDS Impact Model (AIM). To measure the effect of expanding refugee access on public healthcare expenditures, refugee service usage data was obtained from the AIM estimates and costed using treatment expense reports from the literature. Results: South Africa has clear obligations to fulfill refugees’ right to health, including ensuring their access to affordable healthcare. Interventions to improve refugee healthcare access and adherence would reduce the number of HIV-positive refugees, raise the percentage receiving treatment, and reduce the number of AIDS-related deaths. These interventions would cost approximately 201 million dollars over a 10-year period. However, due to the increased usage of potentially cost-saving services like ART, these interventions could also save between 138 and 274 million dollars in healthcare expenditure over the 10-year period. Conclusions: Targeted interventions to improve refugee healthcare access would yield significant refugee health benefits. These benefits would also generate broader public health gains and could even be a cost-saving investment in the long run. These are provocative findings that merit further research and debate, and measures should be taken to respond to the human rights violations outlined herein.