Health insurance and accessibility to health services among Roma in settlements in Belgrade, Serbia—the journey from data to policy making

The Serbian constitution and health-related laws assert that citizens and residents are universally entitled to health care, provided that they hold health insurance. However, until 2010, persons who did not hold a national identification number (ID) were required to present a plethora of documents to be granted one. We assessed the relationship between citizenship, residency and possession of health insurance cards, together with utilization of health services, among Roma residing in disadvantaged settlements in Belgrade. The Roma Health and Nutrition Survey was conducted in 2009 to assess the social determinants of health among Roma. Data were analysed, using logistic regression, to examine health insurance status and utilization of services by citizenship and residency. Eighty-nine per cent of respondents said they were Serbian citizens. Approximately 11% were refugees, 7% internally displaced persons (IDPs) and remainder domicile. Multivariate analysis revealed that non-citizens were more likely to lack health insurance [odds ratio (OR) = 9.2, confidence interval (CI) (3.5, 24.1)], as were refugees and IDPs [OR = 3.1, CI (1.4, 6.9), OR = 4.0, CI (1.4, 11.5), respectively]. Having health insurance was a positive predictor for being seen by a physician [OR = 2.3, CI (1.3, 4.2), OR = 2.3, CI (1.3, 3.9)]. Data from this survey indicated that non-citizen Roma had limited access to health services. These findings led the Serbian Ministry of Health and National Health Insurance Fund to reduce the administrative and legislative hurdles in obtaining health insurance, to ensure the Roma rights to health care. This demonstration of data-driven policies on Roma health could serve as a model for other countries. La constitution serbe et les lois en rapport à la santé affirment que les citoyens et les résidents ont le droit aux soins, à condition qu’ils soient détenteurs d’une assurance de santé. Quoiqu’il en soit, jusqu’en 2010, les individus qui n’avaient pas de numéro d’identification nationale étaient tenus de présenter une multitude de documents pour se voir attribuer un numéro. Nous avons évalué la relation entre la citoyenneté et le statut de résident avec la possession de cartes d’assurance maladie et la fréquentation des services médicaux par les Roms vivant dans des bidonvilles de Belgrade. L’étude sur la santé et l’alimentation des Roms a été menée en 2009 pour évaluer les facteurs sociaux principaux de la santé parmi les Roms. Les données ont été analysé