Switzerland: Aiding the hidden uninsured

These residents, who number in the hundreds of thousands, often lack legal status and/or resources, which complicates their ability to attain needed health care.

Switzerland's health care system requires almost all legal residents to purchase health insurance from one of the country's many private health insurers. Although migrants who are in the country illegally technically have the right to purchase insurance, they face many obstacles in doing so.

Varying laws, differences among insurers in accepting migrants and expensive policies combine to keep them out of the system. Many migrants are unaware that they can buy this insurance, and others hesitate to do so for fear that health authorities could alert the police - although this practice is illegal.

Between November 2003 and October 2004, MSF ran a project in the Fribourg canton, providing care and organizing a network of groups to address the medical and social needs of excluded people.

During this period, MSF staff itself conducted 392 consultations for 180 patients and referred 56 percent of them to other health care facilities for further care. In November 2004, a new local association assumed responsibility for the project. The project will continue to receive support from local health authorities.

With the successful launch and hand over of the Fribourg project, MSF has now turned its attention to Zurich. MSF believes that its exploratory work will reveal many people living in difficult conditions in this large city.

A team plans to assess their needs, determine how much medical care is already available to them, and look at where local groups may already be providing services to them. MSF is also considering carrying out additional evaluations in other parts of the country.

MSF has worked in Switzerland since 2003.