Review

. 2025 Nov:161:105434.

doi: 10.1016/j.healthpol.2025.105434. Epub 2025 Sep 10.

Health care coverage and access for displaced persons from Ukraine: Assessing the implementation of the Temporary Protection Directive across EU Member States

Nicole Mauer¹, Cristina Hernandez-Quevedo², Astrid Eriksen³, Giada Scarpetti³, Ewout van Ginneken⁴; Network of HSPM and country experts

Collaborators, Affiliations

Collaborators

Network of HSPM and country experts:
Anita Gottlob⁵, Timmy van Dijck⁶, Antoniya Dimova⁷, Mincho Minev⁷, Maja Banadinovic⁸, Iva Lukačević Lovrenčić⁸, Elena Gabriel⁹, Marios Kantaris¹⁰, Lenka Šlegerová¹¹, Jana Votápková¹¹, Signe Smith Jervelund¹², Viktoriia Vereshchakina¹², Karsten Vrangbæk¹², Kaija Kasekamp¹³, Kristina Köhler¹⁴, Kaisa Kontunen¹⁵, Dr Outi Linnaranta¹⁶, Dr Natalia Skogberg¹⁶, Marie-Camille Lenormand¹⁷, Julie Galodé¹⁷, Miriam Blümel¹⁸, Lefteris Papagiannakis¹⁹, Krisztina Davidovics²⁰, Viktória Szerencsés²⁰, Gergely Varga²⁰, Prof Sara Burke²¹, Dr Liz Farsaci²¹, Luisne Mac Conghail²¹, Jo Greene²², Antonio Giulio de Belvis²³, Giuseppe Greco²³, Daiga Behmane²⁴, Alina Dūdele²⁴, Laura Miščikienė²⁵, Juliane Winkelmann²⁶, Alexia Bezzina²⁷, Kenneth Grech²⁷, Karen Vincenti²⁷, Madelon Kroneman²⁸, Iwona Kowalska-Bobko²⁹, Gonçalo Augusto³⁰, Inês Fronteira³⁰, Silvia Gabriela Scîntee³¹, Cristian Vlădescu³², Peter Pažitný³³, Pia Vracko³⁴, Ester Angulo-Pueyo³⁵, Enrique Bernal-Delgado³⁵, Clara Lindberg³⁶, Ingrid Schmidt³⁶

Affiliations

¹ European Observatory on Health Systems and Policies, Place Victor Horta 40/30, 1060, Brussels, Belgium. Electronic address: mauern@obs.who.int.
² European Observatory on Health Systems and Policies, LSE Health, London School of Economics and Political Science, Cowdray House, Houghton Street, WC2 2AE, London, United Kingdom.
³ European Observatory on Health Systems and Policies, Berlin Technical University, Department of Health Care Management, Strasse des 17. Juni, 10623, Berlin, Germany; Berlin Technical University, Berlin, Germany.
⁴ European Observatory on Health Systems and Policies, Place Victor Horta 40/30, 1060, Brussels, Belgium; European Observatory on Health Systems and Policies, Berlin Technical University, Department of Health Care Management, Strasse des 17. Juni, 10623, Berlin, Germany; Berlin Technical University, Berlin, Germany.
⁵ Florian Trauner & Marion Weigl, Gesundheit Österreich GmbH, Austria.
⁶ International Relations Department, Federal Public Service Health, Food chain safety and Environment, Belgium.
⁷ Faculty of Public Health, Medical University - Varna, Bulgaria.
⁸ Center for Health Systems, Policies and Diplomacy, Andrija Štampar School of Public Health, School of Medicine University of Zagreb, Croatia.
⁹ Department of Health Science, University of Nicosia, Cyprus.
¹⁰ Health Services and Social Policy Research Centre, Cyprus.
¹¹ Charles University, Faculty of Social Sciences, Institute of Economic Studies, Czech Republic.
¹² Section for Health Services, Department of Public Health, Research University of Copenhagen, Denmark.
¹³ University of Tartu.
¹⁴ WHO country office in Estonia, Estonia.
¹⁵ Department of Health Solutions, Finnish Institute for Health and Welfare, Finland.
¹⁶ Department of Welfare, Finnish Institute for Health and Welfare, Finland.
¹⁷ Caisse Nationale d'Assurance Maladie, France.
¹⁸ Department of Health Care Management, Berlin Technical University, Germany.
¹⁹ Greek Council for Refugees, Greece.
²⁰ Data-Driven Health Division of the National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Budapest, Hungary.
²¹ Centre for Health Policy & Management, Trinity College Dublin, Ireland.
²² Department of Psychology, Maynooth University, Ireland.
²³ Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Rīga Stradiņs University, Latvia.
²⁵ Lithuanian University of Health Sciences, Faculty of Public Health, Lithuania.
²⁶ European Observatory on Health Systems and Policies, Belgium.
²⁷ University of Malta, Malta.
²⁸ Nivel Institute for Health Services Research, Netherlands.
²⁹ Jagiellonian University Medical College, Department of Health Sciences, Institute of Public Health, Poland.
³⁰ NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
³¹ Institutul Național de Management al Serviciilor de Sănătate, București, Romania.
³² Institutul Național de Management al Serviciilor de Sănătate, București and Facultatea de Medicină, Universitatea "Titu Maiorescu", București, Romania.
³³ Prague University of Economics and Business, Czech Republic.
³⁴ National Institute of Public Health, Ljubljana, Slovenia.
³⁵ Data Science for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain.
³⁶ National Board of Health and Welfare, Sweden.

PMID: 40992052
PMCID: PMC12541347
DOI: 10.1016/j.healthpol.2025.105434

Review

Health care coverage and access for displaced persons from Ukraine: Assessing the implementation of the Temporary Protection Directive across EU Member States

Nicole Mauer et al. Health Policy. 2025 Nov.

. 2025 Nov:161:105434.

doi: 10.1016/j.healthpol.2025.105434. Epub 2025 Sep 10.

Authors

Nicole Mauer¹, Cristina Hernandez-Quevedo², Astrid Eriksen³, Giada Scarpetti³, Ewout van Ginneken⁴; Network of HSPM and country experts

Collaborators

Network of HSPM and country experts:
Anita Gottlob⁵, Timmy van Dijck⁶, Antoniya Dimova⁷, Mincho Minev⁷, Maja Banadinovic⁸, Iva Lukačević Lovrenčić⁸, Elena Gabriel⁹, Marios Kantaris¹⁰, Lenka Šlegerová¹¹, Jana Votápková¹¹, Signe Smith Jervelund¹², Viktoriia Vereshchakina¹², Karsten Vrangbæk¹², Kaija Kasekamp¹³, Kristina Köhler¹⁴, Kaisa Kontunen¹⁵, Dr Outi Linnaranta¹⁶, Dr Natalia Skogberg¹⁶, Marie-Camille Lenormand¹⁷, Julie Galodé¹⁷, Miriam Blümel¹⁸, Lefteris Papagiannakis¹⁹, Krisztina Davidovics²⁰, Viktória Szerencsés²⁰, Gergely Varga²⁰, Prof Sara Burke²¹, Dr Liz Farsaci²¹, Luisne Mac Conghail²¹, Jo Greene²², Antonio Giulio de Belvis²³, Giuseppe Greco²³, Daiga Behmane²⁴, Alina Dūdele²⁴, Laura Miščikienė²⁵, Juliane Winkelmann²⁶, Alexia Bezzina²⁷, Kenneth Grech²⁷, Karen Vincenti²⁷, Madelon Kroneman²⁸, Iwona Kowalska-Bobko²⁹, Gonçalo Augusto³⁰, Inês Fronteira³⁰, Silvia Gabriela Scîntee³¹, Cristian Vlădescu³², Peter Pažitný³³, Pia Vracko³⁴, Ester Angulo-Pueyo³⁵, Enrique Bernal-Delgado³⁵, Clara Lindberg³⁶, Ingrid Schmidt³⁶

Affiliations

¹ European Observatory on Health Systems and Policies, Place Victor Horta 40/30, 1060, Brussels, Belgium. Electronic address: mauern@obs.who.int.
² European Observatory on Health Systems and Policies, LSE Health, London School of Economics and Political Science, Cowdray House, Houghton Street, WC2 2AE, London, United Kingdom.
³ European Observatory on Health Systems and Policies, Berlin Technical University, Department of Health Care Management, Strasse des 17. Juni, 10623, Berlin, Germany; Berlin Technical University, Berlin, Germany.
⁴ European Observatory on Health Systems and Policies, Place Victor Horta 40/30, 1060, Brussels, Belgium; European Observatory on Health Systems and Policies, Berlin Technical University, Department of Health Care Management, Strasse des 17. Juni, 10623, Berlin, Germany; Berlin Technical University, Berlin, Germany.
⁵ Florian Trauner & Marion Weigl, Gesundheit Österreich GmbH, Austria.
⁶ International Relations Department, Federal Public Service Health, Food chain safety and Environment, Belgium.
⁷ Faculty of Public Health, Medical University - Varna, Bulgaria.
⁸ Center for Health Systems, Policies and Diplomacy, Andrija Štampar School of Public Health, School of Medicine University of Zagreb, Croatia.
⁹ Department of Health Science, University of Nicosia, Cyprus.
¹⁰ Health Services and Social Policy Research Centre, Cyprus.
¹¹ Charles University, Faculty of Social Sciences, Institute of Economic Studies, Czech Republic.
¹² Section for Health Services, Department of Public Health, Research University of Copenhagen, Denmark.
¹³ University of Tartu.
¹⁴ WHO country office in Estonia, Estonia.
¹⁵ Department of Health Solutions, Finnish Institute for Health and Welfare, Finland.
¹⁶ Department of Welfare, Finnish Institute for Health and Welfare, Finland.
¹⁷ Caisse Nationale d'Assurance Maladie, France.
¹⁸ Department of Health Care Management, Berlin Technical University, Germany.
¹⁹ Greek Council for Refugees, Greece.
²⁰ Data-Driven Health Division of the National Laboratory for Health Security, Health Services Management Training Centre, Semmelweis University, Budapest, Hungary.
²¹ Centre for Health Policy & Management, Trinity College Dublin, Ireland.
²² Department of Psychology, Maynooth University, Ireland.
²³ Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Rīga Stradiņs University, Latvia.
²⁵ Lithuanian University of Health Sciences, Faculty of Public Health, Lithuania.
²⁶ European Observatory on Health Systems and Policies, Belgium.
²⁷ University of Malta, Malta.
²⁸ Nivel Institute for Health Services Research, Netherlands.
²⁹ Jagiellonian University Medical College, Department of Health Sciences, Institute of Public Health, Poland.
³⁰ NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
³¹ Institutul Național de Management al Serviciilor de Sănătate, București, Romania.
³² Institutul Național de Management al Serviciilor de Sănătate, București and Facultatea de Medicină, Universitatea "Titu Maiorescu", București, Romania.
³³ Prague University of Economics and Business, Czech Republic.
³⁴ National Institute of Public Health, Ljubljana, Slovenia.
³⁵ Data Science for Health Services and Policy Research Group, Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain.
³⁶ National Board of Health and Welfare, Sweden.

PMID: 40992052
PMCID: PMC12541347
DOI: 10.1016/j.healthpol.2025.105434

Abstract

Background: Since the beginning of the conflict in Ukraine, close to 4.3 million non-EU citizens have been granted temporary protection in the European Union (EU). Beneficiaries gain access to health care in their host countries. All EU countries must ensure coverage for and access to a minimum set of health care services, but they can arrange delivery and extend the services covered as they deem feasible, necessary, and appropriate.

Objective: The aim is to assess the implementation of temporary protection across 27 EU countries, including legislative provisions and health care coverage foreseen. This study offers a comparative overview of health care entitlements and financial coverage, access to services and barriers encountered in host health systems.

Methods: This study is based on three qualitative survey rounds conducted with members from the EU Health Security Committee and the Health Systems Policy Monitor network (European Observatory on Health Systems and Policies).

Results: All Member States have made the necessary legal provisions. However, large variations in health care benefits and financial coverage exist. The main reported access barriers relate to language, pre-existing capacity limitations, and lacking awareness of provisions on both beneficiary and health care provider sides.

Conclusion: As displaced persons from Ukraine transition into stable living conditions in host countries, data should be collected systematically to ensure health services can be tailored to meet their needs. Better aligning health care provision with other services, such as social care, may help unburden health systems and maximise the use of available resources.

Keywords: Access gaps; Coverage; European Union; Temporary protection; Ukraine; displacement.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to declare.

Figures

Fig 1 — **Fig. 1**
Dimensions of health care access barriers.

See this image and copyright information in PMC

References

1. Temporary protection: European Commission; undated. Available from: https://home-affairs.ec.europa.eu/policies/migration-and-asylum/common-e....
1. Council Directive 2001/55/EC of 20 July 2001 on minimum standards for giving temporary protection in the event of a mass influx of displaced persons and on measures promoting a balance of efforts between Member States in receiving such persons and bearing the consequences thereof, Official Journal L 212, Council of the European Union; 2001. Available from: http://data.europa.eu/eli/dir/2001/55/oj.
1. Council Implementing Decision (EU) 2022/382 of 4 March 2022 establishing the existence of a mass influx of displaced persons from Ukraine within the meaning of Article 5 of Directive 2001/55/EC, and having the effect of introducing temporary protection, Official Journal L 71, Council of the European Union; 2022. Available from: http://data.europa.eu/eli/dec_impl/2022/382/oj.
1. European Union; 2008. Treaty on the Functioning of the European Union. Part THREE: Union policies and internal actions - TITLE XIV: Public Health - Article 168 EUR-Lex.https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A12008E168 Available from:
1. UNHCR Operational Data Portal; 2025. Ukraine refugee situation.https://data.unhcr.org/en/situations/ukraine [20/05/2025]. Available from:

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Health care coverage and access for displaced persons from Ukraine: Assessing the implementation of the Temporary Protection Directive across EU Member States

Collaborators

Affiliations

Health care coverage and access for displaced persons from Ukraine: Assessing the implementation of the Temporary Protection Directive across EU Member States

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials